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Value-Based Care News

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

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Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP report.   Twelve million Americans...

Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

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Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial...

Reference Pricing Models for Prescription Drugs May Contain Costs

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Reference pricing models for prescription drugs may help to contain spending and reduce high costs for beneficiaries, says a new report from the Commonwealth Fund. Currently, most payers use tiered drug formularies to manage drug costs,...

Patient-Centered Medical Home Model Saved BCBS of MI $626M

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BlueCross BlueShield of Michigan has reduced expected spending by $626 million over a nine-year period through a patient-centered medical home (PCMH) model that emphasizes personalized care. The payer found that the PCMH increased rates...

Employers Could See High Financial Returns for Mental Healthcare

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More comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent by employers, says a report from the National Alliance of Healthcare Purchaser Coalitions (NAHPC). One in five...

Poor Healthcare Literacy Leads to $4.8B in Administrative Costs

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Widespread rates of poor consumer literacy within the healthcare industry creates administrative burdens for payers and contributes to an additional $4.8 billion in health plan costs, according to a new Accenture report. Fifty-two percent...

How Payers Can Improve the Value of Long-Term Support Services

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Providing long-term support services (LTSS) impact commercial payers who need to address complications and billions in costs associated with this kind of care. In 2016, the United States spent $92.4 billion on home health care services...

CPC+ Model Offers Payers Insight into Population Health Management

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CMS’s Comprehensive Primary Care Plus (CPC+) model may offer lessons and strategies for payers that want to increase primary care efficiency with population health management strategies. The CPC+ model is the nation’s largest...

86% of Consumers Blame Insurers for Surprise Healthcare Bills

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Eighty-six percent of health plan beneficiaries primarily blame payers for surprise medical bills, according to a survey from NORC at the University of Chicago, indicating that insurers may wish to improve their financial education...

How to Curb Adverse Selection in the Individual Health Plan Market

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Maintaining a profitable individual health plan product is already challenging, but adverse selection can create additional problems that impede a payer’s ability to control health plan costs. Policies within the Affordable Care...

How Can Accreditation Programs Promote Health Plan Value?

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Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures. Many health plans currently participate in the HEDIS performance set and receive...

How Capitated Payments Prompt Payer, Provider Innovation

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The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies. Capitated payments are pre-arranged payments for...

Payers See Cost, Quality Gains with Value-Based Payment Models

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Payers and providers participating in value-based payment models are seeing reduced costs and improvements in care quality.   Value-based payment, which is expected to account for 59 percent of all healthcare payments by 2020, helps...

Value-Based Care Slashes Per Member Per Month Costs in Kansas

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BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs) and patient-centered medical homes...

Payers, Providers Create New Medicare Advantage Partnerships

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New Medicare Advantage plans, many born of innovative partnerships between payers and providers, are creating more options for beneficiaries to supplement their existing coverage with high-value offerings. Commercial payers operating in...

1115 Medicaid Demonstrations Should be Budget-Neutral, CMS Says

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CMS has issued new guidelines for state officials around creating budget-neutral 1115 Medicaid demonstrations. CMS informed state governments that the agency will use a formalized methodology to determine if 1115 demonstrations are a...

How Employers Can Design High-Quality Cancer Care Benefits

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Designing meaningful and high-quality cancer care benefits is a challenge for employer-sponsored health plans.   Cancer, a costly and complex condition that takes many different forms, requires coordination across the entire...

Anthem, Walmart Partner for Over-the-Counter Drug Allowance

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A new partnership between Anthem and Walmart will allow Medicare Advantage beneficiaries to purchase over-the-counter drugs and other drug store necessities with a plan allowance. Starting in January of 2019, Anthem beneficiaries will be...

CMS Tells States to Curb Silver-Loading with Off-Exchange Plans

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CMS is asking state insurance departments to offer more off-exchange health plans in order to reduce silver-loading of qualified health plans (QHP). Silver-loading is the practice of raising premiums so that payers can earn larger federal...

Top 10 Highest Performing Medicare Advantage Health Plans

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Medicare Advantage (MA) plans are growing in popularity as an aging consumer population seeks comprehensive coverage for acute and chronic care needs. A competitive, lucrative market for high-performing plans has emerged, giving payers an...

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