Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Costs

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

May 5, 2017 - Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA). PBMs provide a variety of services, including accurate dispensing of medication, clinical support directly to patients and their caregivers, improving...


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Pharmacy Benefit Managers Help Reduce Payer Drug Spending

by Jesse Migneault

Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA)....

Payer Groups Urge Congress to Keep ACA Cost Sharing Reductions

by Jesse Migneault

In a recent letter to the President and leading members of Congress, insurance payer groups and the nation’s largest provider organizations detailed their case to retain the cost sharing reductions (CSR) provision in the ACA.  Payers...

NY Senate Considers Proposal for Single Payer Healthcare

by Jesse Migneault

Since the future of the Affordable Care Act (ACA) remains unclear, and GOP plans to repeal and replace have stalled, states are taking the lead in finding solutions to the rising costs of health care.  New York has joined California as the...

Minn. Healthcare Payers Reported $687M in Financial Losses

by Thomas Beaton

Local healthcare payers in Minnesota reported financial losses of $687 million due to the rising gaps in premiums and healthcare spending. The Minnesota Council of Health Plans gathered statewide data from insurance companies and HMOs, and found...

CHIP Funding Cuts Would Leave 8M Low-Income Kids Uninsured

by Thomas Beaton

More than 8 million low income children living with chronic diseases would lose healthcare coverage and incur higher costs if CHIP funding is not extended beyond 2017, says new research from the Yale School of Medicine. In a study published in...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

by Thomas Beaton

Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

Prescription Drugs Account for 22% of Payer Premium Spending

by Thomas Beaton

Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

Kansas Lawmakers Vote for Medicaid Expansion Under the ACA

by Thomas Beaton

UPDATE: Kansas Governor Sam Brownback has vetoed the legislation, calling Medicaid expansion "irresponsible and unsustainable." Kansas state lawmakers in the House and Senate have voted to approve Medicaid expansion under the Affordable...

Out-Of-Pocket Healthcare Spending on the Decline Since 2000

by Thomas Beaton

The Agency for Healthcare Research and Quality (AHRQ) reported that out-of-pocket healthcare spending decreased for all age groups between 2000 and 2014. A statistical brief of the report presents data from the Household Component of the Medical...

Healthcare Leaders Air Concerns about NQF SDS Trial Period

by Thomas Beaton

A group of healthcare organizations wrote a letter to the National Quality Forum (NQF) calling for a one-year extension of the Sociodemographic (SDS) Trial Period that evaluates how social factors impact a hospital's or provider’s ability...

Emergency Coverage Top Healthcare Consumer Demand For Payers

by Thomas Beaton

A new poll from the American College Of Emergency Physicians (ACEP) and Morning Consult found that 95 percent of healthcare consumers say payers should cover emergency services. Out of the 1,791 healthcare consumers surveyed, about 31 percent...

Experts Lay Out Strategy for Achieving Universal Coverage

by Thomas Beaton

Experts from the Harvard Business School, Duke University, and David Geffen School of Medicine at UCLA debate the viability of an individual mandate as a means of achieving universal coverage without a single payer. According to Regina Herzlinger,...

Does Tiered Cost-Sharing Promote Appropriate Medication Use?

by Jacqueline Belliveau

Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care & Specialty Pharmacy study found that stakeholders...

CMS Releases Final Rule for Medicare Physician Fee Schedule

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS press release states. The new payment policies...

Medicare Diabetes Prevention Program Saves $2,650 per Patient

by Vera Gruessner

In March 2016, the Department of Health & Human Services (HHS) proposed the expansion of Medicare coverage for the Diabetes Prevention Program. The funding for this program comes from the Affordable Care Act and research shows that Medicare...

Premium Rates on Affordable Care Act Exchanges Rise 25% in 2017

by Vera Gruessner

Monthly premium costs on the Affordable Care Act exchanges is expected to rise an average of 25 percent in 2017, according to a report from the Department of Health & Human Services (HHS). This percentage is based solely on the premiums for...

Why Aetna, Humana Argue in Favor of Health Insurance Merger

by Vera Gruessner

On July 21, the Department of Justice (DOJ) announced during a press conference that they would be filing a lawsuit against two health insurance mergers between Aetna-Humana and Cigna-Anthem. The DOJ claimed that these health insurance mergers...

Prescription Drug Medical Costs Less Problematic due to ACA

by Vera Gruessner

Recently, criticism popped up against the pharmaceutical company Mylan from the Hillary Clinton presidential campaign for its significant price increase for the life-saving EpiPen product. The EpiPen is vital in an emergency when a person who...

4 Motives Why Hospitals Adopt Provider-Sponsored Health Plans

by Vera Gruessner

Due to the many new transformations taking place within the healthcare industry today such as the transition from fee-for-service reimbursement to value-based care payments, the potential for creating provider-sponsored health plans has grown...

Is the ACA’s Health Insurance Provider Fee Unconstitutional?

by Vera Gruessner

Last year, six states including Texas, Wisconsin, Kansas, Louisiana, Indiana and Nebraska filed a lawsuit arguing that a provision within the Affordable Care Act requiring states to cover a Health Insurance Provider Fee is unconstitutional and...

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