Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Patient Safety

Insured Critical Illness Beneficiaries Face High Treatment Costs

October 22, 2018 - Health plan members with critical illnesses face high treatment costs and other financial issues even with comprehensive health insurance, said a new survey conducted by the Harvard T. Chan School of Public Health, New York Times, and Commonwealth Fund. Nine out of ten commercially insured beneficiaries with illnesses like cancer or immune deficiency diseases have health insurance, the...


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IL Payers File Pharma Lawsuit Over Opioid Prescription Costs, Safety

by Thomas Beaton

A coalition of Illinois payers has sued prominent pharmaceutical companies in a lawsuit that argues the companies are responsible for a spike in opioid prescription costs and patient safety risks. The Intergovernmental Risk Management...

PA Expands Access to Medication Assisted Treatment for SUD

by Thomas Beaton

Commercial payers and the Pennsylvania Department of Insurance (PDI) have agreed to increase access to medication-assisted treatments (MAT) and realign prior authorization processes for beneficiaries struggling with substance use disorders...

OIG Finds Profits to Blame for Denied Medicare Advantage Claims

by Thomas Beaton

Fifty-six percent of Medicare Advantage (MA) payers inappropriately denied claims from beneficiaries and providers to potentially profit from the capitated payment system, according to a report from the Office of Inspector General...

Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

by Thomas Beaton

Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns, says a report from the National Council...

FDA Recruits Payers to Submit Quality Feedback on Medical Devices

by Thomas Beaton

FDA has launched a new quality assurance program that leverages feedback from commercial payers about medical device coverage requirements in order to expedite approvals. The Private Payor Program (PPP) is a voluntary program for medical...

AMA Expresses Concern with Medicare Part D Formulary Changes

by Thomas Beaton

New Medicare Part D formulary policies introduced by CMS in August may increase patient safety risks and complicate the prior authorization process, said AMA President Barbara L. McAneny, MD, to HealthPayerIntelligence.com. In an emailed...

CAQH CORE Urges Industry Collaboration on Prior Authorizations

by Thomas Beaton

CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations. Leading provider and payer organizations, including AHIP, AHA, the BlueCross...

CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

by Thomas Beaton

CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome...

How Payers Address the Nation’s Opioid Crisis, Patient Safety

by Thomas Beaton

Commercial payers leverage community financing and engagement techniques to limit patient safety risks related to the nation’s opioid crisis. Payers find that contributing information to datasets can help stakeholders detect opioid...

BCBS Association: Use Alternative Pain Therapies Before Opioids

by Thomas Beaton

The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and...

Prior Authorization Issues Contribute to 92% of Care Delays

by Thomas Beaton

Prior authorization issues are associated with 92 percent of care delays and may contribute to patient safety concerns as well as administrative inefficiencies, according to a new survey from AMA. Payers should work to change their prior...

Payers Address Opioid Safety Via Education, $0 Narcan Co-Pays

by Thomas Beaton

Commercial payers are addressing the nation’s opioid crisis and promoting opioid safety by funding patient education programs and waiving Narcan co-pays to reduce barriers to access. Patient-centered strategies have allowed payers...

CA to Investigate Aetna after Insurance Claim Review Admission

by Thomas Beaton

The California Insurance Commission has opened an investigation into Aetna’s medical practices after a former medical director for the company testified in court that he did not review patient records before approving or denying...

AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

by Thomas Beaton

An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to...

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

by Thomas Beaton

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

by Thomas Beaton

Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in...

BCBS Ohio Plans for Upping Patient ED Visit Costs Raise Concerns

by Thomas Beaton

BCBS of Ohio plans to charge beneficiaries the total cost of their emergency department visits  if a diagnosis suggests the visit wasn’t emergency-based, a policy which has been met with extensive concern from The American...

Consumers Support Laws to Limit Payer Prescription Switching

by Thomas Beaton

The vast majority of patients living with chronic diseases would support legislation to limit a payer’s ability to switch their prescriptions without medical necessity, according to a new series of surveys.   Ninety-four...

Aetna to Waive Narcan Co-Pays, Combat Opioid Overprescribing

by Thomas Beaton

Aetna will be the first national payer to waive Narcan co-pays for fully-insured members as part of a larger effort to address the nation’s opioid crisis, the payer announced in a press release. Narcan is considered a preferred...

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