MA Senate Aims To Reduce Drug Spending With Step Therapy Reform
The Massachusetts State Senate has passed a bill that would introduce step therapy reform, restricting a practice that payers commonly use to decrease patient prescription drug...Commercial High Deductible Plans May Not Impact Member Outcomes
Contrary to expectations, there may not be a correlation between deductible costs and member outcomes for commercial high deductible plans, according to a study published in JAMA Open Network. The...Digital Wellness Program Saw High Member Engagement After COVID-19
Updated 7/22/20: This article has been updated to reflect that Wellvolution is a Blue Shield of California program. A previous version said Blue Shield of California partnered with...Top Chronic Diseases Behind Payer Spending And How to Prevent Them
The Centers for Disease Control and Prevention (CDC) estimates that 90 percent of national healthcare spending goes toward chronic disease management and mental healthcare, which means that strong...Member Engagement Requires Advanced Analytics, Specialized Team
Member engagement strategies need to make better use of advanced analytics, be more attuned to members’ journeys of care, and culminate in a tight, dedicated team with a broad range of...Payer Extends Value-Based Contracting to Dental Provider Group
Blue Cross Blue Shield of Massachusetts (Blue Cross) is expanding its value-based care model into its dental plan through value-based contracting with the dental provider group 42 North. In 2019,...Aetna Offers Atlanta Employers Fully-Insured, Self-Insured Plans
Aetna Whole Health will offer employers access to self-insured and fully-insured plan options that focus on better care coordination through accountable care organizations (ACOs) and incorporating...Using Value-Based Care to Tackle Maternal Health Disparities
Priority Health, the second largest health plan in the state of Michigan, will financially offset the cost to providers who use the Centering Healthcare Institute’s (CHI) CenteringPregnancy...3 Ways Payers Drive Population Health Management in Cancer Care
The industry’s transition into value-based care is characterized by a focus on data and patient centered care. By driving strong population health management, payers can excel in this value-based...Medicaid Expansion May Impact Patient Outcomes in Southern States
Medicaid expansion may impact patient outcomes and coverage in low-income populations in the southern states, according to a recent study published by Health Affairs. The study surveyed and extracted...CMS: Medicare Will Cover Genetic Diagnostics For Certain Cancers
Medicare will now cover Next Generation Sequencing for beneficiaries with inherited ovarian or breast cancer in order to improve their precision medicine treatment options, CMS...2017 State Medicaid Spending Rose as Feds Withdrew Funding
As the promise of federal funding slacked in 2017, states put more of their own funds toward their Medicaid programs, with Medicaid spending absorbing 17 percent of overall state-generated funds,...Data Sharing, Teamwork Essential to Pediatric Value-Based Care
Cooperation with providers and data sharing are key to success in pediatric value-based care, Horizon Blue Cross Blue Shield New Jersey (BCBSNJ)’s 2018 care quality results show. “Horizon...Mergers and Acquisitions Will Strengthen Payer Identity in 2020
Payers will seek to strengthen their identities in 2020 and they will use mergers and acquisitions as the tools for transformation, according to a recent HRI’s PricewaterhouseCoopers (PwC)...3 Strategies for Payers to Improve Member Medication Adherence
Ensuring members’ medication adherence is a step toward decreasing payers’ overall costs and improving patient outcomes. But medication adherence is highly personal territory that can be...TN Is First State to Seek Block Grant to Lower Medicaid Spending
Tennessee is the first state to seek a block grant waiver for its Medicaid program. “The traditional model of Medicaid financing is an outdated model of fundamentally misaligned...Health2047 Launches Medicare Advantage Plan to Address SDOH
California-based Health2047’s new health plan, Zing Health, will offer a Medicare Advantage plan that aims to address social determinants of health, the company announced. "Zing Health is...BCBSAZ Tackles Medication Adherence Through Mobile Health
Blue Cross Blue Shield Arizona (BCBSAZ) is using text message-based patient outreach to address prescription drug affordability and medication adherence, BCBSAZ announced. The healthcare payer has...Wellness Program Success Hinges on Long-Term Participation
Members highly engaged in Humana’s long-term wellness program, Go365, spent on average $116 less per member per month in healthcare costs than low-engaged participants, a five-year study...Sponsored Article
