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Value-Based Care News

Single-Employee Businesses Experience High, Burdensome Premiums

November 16, 2017 - Single-employee businesses paid an average of $500 per month on premiums, experienced high premium payment growth, and experienced polarizing financial burden based on their premium payment amounts, a new report from JPMorgan & Chase reveals. Single-employee health insurance premium payments (HIPP) grew at an average of 8.3 percent in 2016, while multiple employee-sponsored (20 or more...


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Payer Housing Programs Address Social Determinants of Health

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Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services. A new report from the...

Value-Based Care Outperforms Fee-for-Service Health Plans

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Health plans that include value-based care (VBC) principles are more cost-effective than fee-for-service (FFS) options and are starting to produce better patient outcomes, Humana asserts in a new report. The total healthcare costs associated...

44% of Employees Don’t Know Value of Health Plan Benefits

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Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research published...

Payer Strategies for Improving Member Medication Adherence Rates

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Payers are spending billions of dollars annually on medications that aren’t improving the health outcomes, with financial and health literacy proving to be the most common barriers to adherence. Avoidable healthcare spending totaling between...

Top 4 Consumer Wellness Benefits for Payers to Add to Health Plans

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As payers explore innovative ways to improve beneficiary engagement and satisfaction, they may wish to consider adding enhanced consumer wellness benefits to their health plan offerings. Health plans that take a proactive approach to engaging...

Why the Generic Drug Market is a Growing Payer Opportunity

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As payers try to ease the rising costs of prescription drugs, which account for 10 percent of national healthcare spending, they may wish to turn to the generic drug market to help curb unnecessary spending and improve profitability.   Generics...

Improving Price Transparency around Generic Drugs for Payers

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Increasing pricing transparency around generic drugs could offer significant advantages to payers, including lower prices and more favorable reimbursement negotiations, according to a report from USC Brookings. Better understanding of contracting...

3 Value-Based Pharmaceutical Contracting Options for Payers

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Value-based pharmaceutical contracting offers health payers the option to lower drug prices while improving patient outcomes. These contracts come in several different forms, according to Dr. Surya Singh, Chief Medical Officer of CVS Specialty,...

AHIP Launches Initiative To Combat Nationwide Opioid Crisis

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AHIP launched the Safe, Transparent Opioid Prescribing (STOP) Initiative to support health plans’ widespread adoption of clinical guidelines for pain care and opioid prescribing, and combat the national opioid crisis, the organization announced...

How the Medicare Advantage Market Can Offer Payer Opportunities

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Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address developing...

Mercy Health, Centene Form Medicaid Accountable Care Organization

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Mercy Health of Arkansas and the Centene Corporation have received approval to operate an accountable care organization within the state focusing on Medicaid beneficiaries, the organizations announced in a press release. Centene subsidiaries...

Only 30% of Employers Get Pharmacy Benefit Manager Contracts

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Only 30 percent of employers have a complete understanding of their pharmacy benefit manager (PBM) contracts, according to a new survey from the National Pharmaceutical Council (NPC). Just 40 percent of the 88 employers participating in the survey...

Medicare Consumers Prefer Phone Calls from Health Plans

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Medicare consumers tend to prefer traditional phone calls or mailings over digital engagement strategies such as text messaging or using a member portal, according to a new Healthmine survey. Forty-eight percent of Medicare consumers aged 65...

Payer Strategies for Boosting Consumer Engagement, Satisfaction

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In an increasingly competitive health insurance environment, payers that can successfully increase consumer engagement and beneficiary satisfaction will be best positioned for success. David Biel, the US Leader for Health Plans consulting at...

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

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Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to...

How to Create Balanced Risk Pools that Lower Premiums

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Payers have been increasingly challenged to manage the high cost of healthcare while lowering the premiums their beneficiaries pay.  Creating balanced risk pools that benefit medically complex individuals while also serving healthier consumers...

High-Deductible Health Plans Reduce Care Costs, Needed Services

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High-deductible health plans (HDHPs) may reduce spending, but are also prone to preventing health care consumers from accessing necessary services and recommended preventive care, according to a study published in Health Affairs. High-deductible...

Health Plan Consumers Report Insufficient Payer Communications

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Health plans may not be effectively communicating with consumers about member  benefits and largely fail to understand their members’ health and financial needs, a survey from Healthmine found. A sample of 750 consumers enrolled in...

80% of Payers Investing in Member Engagement, Satisfaction

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Eighty percent of health plans are focusing on improving member engagement and consumer satisfaction, according to a survey by Change Healthcare.   Member engagement is a growing opportunity for payers because of the potential improvements...

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