Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

Top 10 Healthcare Spending Categories in the United States

September 20, 2017 - The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based contracting has started to slow the growth curve, but the industry still spends $3.2 trillion on a wide variety of services, according to the latest data from CMS...


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How Pharmacy Benefit Managers Lower Prescription Drug Prices

by Thomas Beaton

Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS...

More Payers, More Providers Increase Price Negotiation Power

by Thomas Beaton

Payers that operate within healthcare markets with a high concentration of payers and providers prices can negotiate the price of services up to 19 percent lower than those operating in low-concentration payer-provider markets, found a new study...

Pharmacy Benefit Manager Accountability is Key for Employers

by Thomas Beaton

As prescription drug costs continue to rise employers should ensure that they have strong pharmacy benefit manager (PBM) accountability measures in place to maximize cost-savings and plan efficiency, according to a report from the Midwest Business...

Narrow Provider Networks are 16% Cheaper for ACA Plans

by Thomas Beaton

Economists from Harvard Business School and Northeastern University found individual ACA silver plans with narrow provider networks were 16 percent cheaper for consumers and offer payers a promising savings opportunity in the commercial market....

AHIP, AMA, AHA to Congress: Fund Cost Sharing Reductions to 2019

by Thomas Beaton

AHIP, AMA, and AHA and four other healthcare organizations urged Congress to continue funding cost sharing reductions (CSRs) through 2019, warning of continued instability in the health insurance marketplace and higher premiums if the CSRs were...

Cost of Implementing Quality Measures Key for Value-Based Care

by Thomas Beaton

Healthcare payers and providers must develop a better sense of the costs and burdens of implementing quality measures if they are to succeed with value-based care, according to the authors of a recent commentary in JAMA. Leaders from Boston Children’s...

Competitive Bidding Curbs Medicare Durable Medical Equipment Costs

by Thomas Beaton

A research team from the Health Care Cost Institute (HCCI) found that the Competitive Bidding Program (CBP) lowered Medicare costs on durable medical equipment (DME), bringing spending down to levels experienced by many commercial payers. The...

How Preventive Healthcare Services Reduce Spending for Payers

by Thomas Beaton

Reducing healthcare spending is a multi-faceted challenge for payers that requires creative and innovative strategies like offering a wide range of preventive healthcare services in health plans. Payers that encourage beneficiaries to take advantage...

Employers Must Prepare Retirees for $275K in Expected Care Costs

by Thomas Beaton

Employers are starting to prepare and educate retirees for expected post-retirement care costs of $275,000, according to market analysis published by Fidelity Investments. The analysis found a 6-percent increase in costs over a similar report...

Small Employer Health Plan Quality on Par with Larger Groups

by Thomas Beaton

Small employer health plans can deliver similar levels of quality with many of the same cost controls as larger employers, according to new research from United Benefits Advisors (UBA). A “less is more” approach can provide significant...

Employer Reference Pricing Lowers Prescription Drug Expenses

by Thomas Beaton

As payers and employers learn to counter significant increases of prescription drug expenses, reference pricing may hold the key to lowering drug spending and increasing consumer purchases of lower cost drugs, according to research published...

Stop-Loss Insurance a Growing Market Opportunity for Healthcare

by Thomas Beaton

Even though payers may experience higher total revenues on commercial self-insurance, stop-loss and third-party protected insurance revenues have been growing at a higher rate with stronger market stability according to market research from AM...

Explaining Out-of-Pocket Costs May Ease Cancer Care Stress

by Thomas Beaton

Patients who are not prepared for the magnitude of their out-of-pocket costs for cancer care are more likely to be distressed and less likely to pay their bills than other individuals, according to a research letter published in JAMA Oncology....

Can Healthcare Price Transparency Tools Cut Costs for Payers?

by Thomas Beaton

As out-of-pocket costs for patients continue to rise alongside payer spending on services, many health insurance companies are turning to online price transparency tools to help beneficiaries decide how to purchase low cost, high quality care....

Employers Expect 2018 Benefit Costs to Rise $14K Per Employee

by Thomas Beaton

Large employers will have to rely on healthcare delivery innovations and cost management strategies as employers face a 5 percent rise in the cost of providing employee healthcare benefits, according to a National Business Group on Health (NBGH)...

Employer Cost Management Strategies Combat High Insurance Costs

by Thomas Beaton

Employers expect healthcare spending to increase by 5.5 percent in 2018, up from a 4.6 percent increase in 2017, according to a Willis Towers Watson survey. The continued rise in costs has turned health cost management as a top employer concern,...

Large Employers Aim to DRIVE the Expansion of Value-Based Care

by Thomas Beaton

Large employers are deeply invested in bringing down healthcare spending rates, and have embraced value-based care strategies for ensuring that their employees stay as healthy and productive as possible. As care costs continue to rise across...

Increasing Competition Can Reduce Prescription Drug Prices

by Thomas Beaton

Reducing prescription drug prices for payers requires market-based solutions that increase competition and deregulate federal drug policies, the Pharmaceutical Care Management Association (PCMA) wrote in a letter to HHS secretary Tom Price.  ...

BCBS of Louisiana Offers Online Consumer Price Comparison Portal

by Thomas Beaton

In an effort to improve transparency and customer engagement, Blue Cross Blue Shield (BCBS) of Louisiana launched an online consumer price comparison portal. The portal, called SmartShopper, allows any BCBS  customer in Louisiana to compare...

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