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Value-Based Care News

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...

Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

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A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health Politics,...

Beneficiary Segmentation, Spending by Healthcare Payer Type

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Healthcare spending in the US continues to grow steadily across all beneficiary segments and healthcare payers. 2015 data from CMS, the CDC, and the Kaiser Family Foundation (KFF) indicates that payers and individuals sponsoring their own healthcare...

Payer Pricing, Partnership Strategies for Population Health

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Effective population health management and comprehensive preventive care open the door to new opportunities that maximize payer spending, raise care quality, and slow the progression of costly chronic conditions such as diabetes and cardiovascular...

Payers Driving Value by Promoting Connected Care Models

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As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future. Rising healthcare costs are...

Large Variations Seen in Consumer Healthcare Spending

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As healthcare costs rise, beneficiaries will be more responsible for out-of-pocket healthcare expenses not covered by their health plans. But those costs drastically vary by state, family size and income, and other variables, according to a report...

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

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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...

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...

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