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Value-Based Care News

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

September 21, 2017 - Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a PricewaterhouseCoopers report. Only 25 percent of pharmaceutical companies are participating in these contracts, and another 14 percent weren’t sure...


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Top 10 Healthcare Spending Categories in the United States

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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...

Medicaid Analytics Support Social Determinant Incentive Payments

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Payers looking for innovative ways to control the costs of care have been turning their attention to the social determinants of health, the non-clinical factors that often lead to issues with care access, non-adherence, and the development of...

Narrow Provider Networks are 16% Cheaper for ACA Plans

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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....

Cost of Implementing Quality Measures Key for Value-Based Care

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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...

Medicare Shared Savings Program ACOs Cut Spending by $1 Billion

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Accountable care organizations in the Medicare Shared Savings Program (MSSP) lowered net spending by $1 billion and could help control high expected Medicare spending in the future, a report from the Office of the Inspector General (OIG) found....

How Preventive Healthcare Services Reduce Spending for Payers

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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...

ACA Risk Adjustment Leads Northwell to Shutter Insurance Plan

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Northwell Health will end the sale of its CareConnect health plans in New York after hefty risk adjustment payments resulted in financial losses for the program, the health system announced. ACA risk adjustment payments totaling $112 million...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

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Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared a national...

Employer Reference Pricing Lowers Prescription Drug Expenses

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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...

Tufts Health Plan Launches Four Medicaid ACO Partnerships

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Tufts Health Plan has signed contracts to form Medicaid accountable care organizations (ACOs) with Atrius Health, Beth Israel Deaconess Care Organization, Cambridge Health Alliance, and Boston Children’s Hospital ACO, according to a press...

Latest Earnings Reports Show State of Health Payers in 2017

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At the half-year mark, payers have a good sense of how well their efforts to promote value-based care have fared and the opportunity to make the necessary adjusts where they have not. As part of the business-facing side of value-based care, payers...

Payer Collaboration Can Address Social Determinants of Health

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Billions in overspending on medical costs are attributed to social determinants of health (SDOH), and SDOH can identify if beneficiaries covered by insurance plans are at risk for adverse health conditions outside their coverage. SDOH include...

Effective Steps for Health Insurance Marketing, Consumer Engagement

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Creating and deploying effective health insurance marketing and consumer engagement plans can be difficult for payers in today’s complex purchasing landscape.   Payers must focus on building strong brands, clear messaging, and effective...

Boston Children’s, Cleveland Clinic Partner for Pediatric Care

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Boston Children’s Hospital and Cleveland Clinic have announced a partnership to provide complex pediatric heart care through Cleveland Clinic’s national employer-based insurance network. “Together, our goal to develop and provide...

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

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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...

Can Healthcare Payers Inspire ACOs to Take on Two-Sided Risk?

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While two-sided risk arrangements are attractive for healthcare payers, even experienced accountable care organizations (ACOs) are wary of jumping into contracts which make them financially responsible for falling short of their quality benchmarks. ...

Opioid Use Fell 32% in CA BCBS Prescription Drug Safety Program

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The Blue Shield of California Health Plan, an independent member of Blue Cross Blue Shield (BCBS), successfully lowered overall opioid use by 32 percent during the first two years of its Narcotic Safety Initiative (NSI).   The NSI leveraged...

Top 10 Most Expensive Chronic Diseases for Healthcare Payers

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Chronic diseases are on the rise in the United States, leaving healthcare payers with the challenge of covering care for patients with these expensive, long-term conditions. Chronic diseases are such a costly healthcare endeavor that experts...

Humana, Oscar Health to Deliver Small Business Insurance

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Humana and startup insurance provider Oscar Health have entered into a strategic partnership that aims to provide commercial small business insurance to consumers in a nine-county area surrounding Nashville, TN. The partnership merges Humana’s...

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