HealthEdge survey: Costs are top-of-mind for health plan leaders
When asked what their biggest difficulties are today, 46% of payer leaders said managing costs and 41% said driving operational efficiencies. The reason for this […]
When asked what their biggest difficulties are today, 46% of payer leaders said managing costs and 41% said driving operational efficiencies. The reason for this […]
Many employed Americans misunderstand their health insurance plans, and 72% want someone to just tell them what the best plan is for their specific needs, […]
More and more pharma companies are looking “beyond the pill” when it comes to providing care for patients, few more so than Eisai, which is […]
Despite having insurance, too many patients with HIV face high out-of-pocket costs for brand medicines. This is largely driven by insurer-imposed barriers that shift the […]
Sanjula Jain, PhD., Chief Research Officer, Trilliant Health Driven by headlines and incomplete, misleading data that favor a telehealth narrative, health systems and healthcare investors […]
Jessica Bonham-Werling, Payer and Provider Solutions Marketing at Redox The Institute for Healthcare improvement indicates that twice as many healthcare organizations cite health equity as […]
Skyrocketing medical bills and a lack of understanding in the healthcare system is putting financial stress on Americans in 2022, several recent reports have found. […]
Siddharth Thakkar, VP, Product and Marketing at IKS Health For the better part of a decade, the shift toward value-based care in the U.S. has […]
West Virginia took a big step towards making insurance work like it should last week. As of July 1, thanks to bipartisan state legislation passed […]
A recent Ipsos/PhRMA survey of more than 2,500 registered voters paints a clear picture of health care issues that keep them up at night: insurance […]
How do efficiently is care provided for patients at Veteran Affairs’ hospitals as compared to private hospitals? This is not an easy question to answer […]
In today’s broken insurance system, patients too often pay more for a medicine than what their insurance company pays.
Prior authorization is a pain. A paper by Howell et al. (2021) found that the total cost of various utilization management schemes is $93.3 billion […]
Patricia (Pat) Black, Director of Technical Solutions at Cardinal Peak When it comes to your health and treatment, hospitals leverage a variety of sensors and […]
Michael Gardner, Chief Strategy Officer at Virsys12 As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a […]
Many Americans battle with an illness every day, but unfortunately for some, their illness is not the only battle they face. A recent Morning Consult/PhRMA […]
What You Should Know: – Take Command, a tech-enabled service that offers HRA administration, has acquired innovative HRA intellectual property assets from Savvy, a San Francisco-based, […]
In comments submitted to the Federal Trade Commission (FTC), PhRMA urged the agency to examine how pharmacy benefit managers (PBMs) leverage their extraordinary power to […]
More than 1,150 medicines were excluded from at least one of the three largest PBMs’ standard commercial formularies in 2022, according to a new report […]
Recently the CBO published a report compared the rates public and private insurers pay to hospitals for inpatient services, for services at hospital outpatient departments […]
U.S. hospitals have been stuck with more than $702 billion in uncompensated care costs for the past 2 decades, and the number continues to grow. […]
The COVID-19 pandemic has made clear how important a stable health care system is to the American people, both during times of crisis and beyond. […]
A recent Patient Experience Survey found that Americans with serious chronic conditions, including autoimmune diseases, mental health conditions and neurologic conditions were more likely than […]
Is telehealth over before it began? Let’s hope not. First, there is the clinical aspect. While telehealth was vital during the pandemic, it is unclear […]
Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does […]
Today, we’re taking a closer look at Americans’ leading concerns and what issues they want policymakers to prioritize.
According to a new Ipsos/PhRMA poll, most Americans — 82% — agree that lowering out-of-pocket costs for health care should be a top priority for […]
In many markets, however, we observe that lower income individuals do not purchase the most generous forms of health insurance. For instance, despite the passage […]
Many countries allow private plans to administer health insurance benefits but with restrictions on premiums and with the potential for risk adjusted government payments based […]
While insurers negotiate steep discounts on medicines, they don’t always share these savings directly with patients. In recent years, insurers have shifted costs for brand […]
What You Should Know: – Vital Start Health, a University of Pennsylvania startup and a member of Microsoft for Startups, has launched COURAGE as the next-generation, virtual reality, […]
Are narrow networks a good thing or a bad thing? The first thing you need to know is what is a “narrow network”. Narrow networks […]
For many individuals with employer-provided health insurance, a recent paper by Liu and Sydnor (2022) find that this is indeed the case. The authors use […]
Value-based healthcare puts the focus on patient outcomes, but payers have a part to play as well. A panel at MedCity News’ INVEST conference discussed […]
Nearly half of insured Americans who take prescription medicines encounter affordability and access barriers to care, according to the findings of the newest installment of […]
Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question […]
Venture Capital, Private Equity, Mergers & Acquisitions (M&A) Activity Glooko Acquires DIABNEXT® to Expand Diabetes Offerings in France Glooko, a leading provider of remote patient […]
The U.S. Department of Veterans Affairs (VA) primarily provides medical coverage for veterans who have experienced service-related disabilities. Its unique system was developed to meet […]
Concerns about inflation continue to be top of mind for many Americans, as prices for basic services and necessities climb at a rapid pace. But there […]
What You Should Know: – Flume Health, a NYC-based Health-Plan-as-a-Service platform announced today a $30M round of Series A funding led by Optum Ventures with […]
In a February 10th speech, President Biden wanted to end surprise bills for patients. Specifically he said: No more surprise billing. No more. In fact, […]
What You Should Know: – XRHealth, the gateway to the healthcare metaverse, announced today that they raised $10M in funding to expand virtual healthcare treatment in the Metaverse. The […]
The second installment of the Patient Experience Survey finds insurer-imposed practices pose significant barriers for Americans as they attempt to access the care they need […]
Sajjad Kamal, Healthtech Partner at Global Ventures Nazmus Saquib, HCI & Interfaces Expert Tools we use to do our daily work have rapidly evolved following […]
What You Should Know: – Today, TytoCare has partnered with Alice, Brazil’s first primary care-driven health insurance plan, to expand Alice’s telehealth offerings with at-home medical examinations. – The partnership will mark […]
What You Should Know: Equip, a provider of virtual, evidence-based eating disorder treatment in the U.S., today announced a $58M Series B funding round, bringing […]
According to a recent paper by Kim and Koh (2022), the answer is ‘yes’. Using data from BRFSS and PSID, the authors use a difference-in-difference […]
In comments submitted this week, PhRMA urged the Centers for Medicare & Medicaid Services (CMS) to withdraw its proposed national coverage determination (NCD) for monoclonal […]
Should your employer offer you a single health plan type or is it better to be offered a menu of health insurance options that vary […]
For any patients–but especially those with neurodevelopmental illnesses such as schizophrenia–have a consistent ‘medical home’ is vital for continuity of care. However, having consistent access […]
PhRMA submitted comments this week in response to the Department of Health & Human Services’ (HHS) 2023 Notice of Benefit and Payment Parameters (NBPP) proposed […]
This is a few years old, but still very relevant. It’s from a speech by former FDA Commissioner Scott Gottlieb on March 7, 2018 titled […]
No one should struggle to afford the medicines they need. Unfortunately, some patients continue to bear more of their medicine costs at the pharmacy counter. […]
Lagging behavioral health and substance use treatment benefits are a major barrier to care, especially for those already struggling to get help. The Departments of […]
The Congressional Budget Office (CBO) recently released a new report looking at trends in spending, prices and use of prescription drugs. While some politicians are […]
By KIM BELLARD Happy New Year! We’re starting 2022 full of hope and renewed optimism. Oh, wait; not so much. We’re not only still in […]
Health Care Payment Learning and Action Network (HCP LAN) is dedicated to moving the health care system from volume-based, fee-for-service reimbursement, to alternative payment models […]
Specialty drugs have delivered significant improvements to patient health, but oftentimes they pay be expensive. To try to insure that these treatments are used appropriately, […]
Chini Krishnan, co-founder and CEO of GetInsured Since the launch of the Affordable Care Act, we have seen federal administrations come and go. Yet throughout […]
3 in 10 insured Americans still face a financial barrier to care and some of the most vulnerable patients are also those more likely to […]
If you are on Medicare, how much will you pay for insulin? The answer is in the graph below (via MedPAC’s Payment Basics) Seem confusing? […]
Cost sharing is just that, sharing in the cost of providing a health care service. While health insurers often pay for a large share of […]
A new study from the Employee Benefit Research Institute (EBRI) compared the difference in price for 72 physician-administered outpatient medicines – representing 73% of medicine spending […]
By HANS DUVEFELT I have a patient with no health insurance but a brand new Mercedes. He says he can’t afford health insurance. He cringes […]
8 Physician Employment Contract Items You Need to Know About More and more physicians are signing employment contracts as opposed to opening up a practice. […]
By MIKE MAGEE In this world of political theatrics, with Democratic legislators from Texas forced into exodus to preserve voters’ rights, and Tucker Carlson rantings […]
Included Health, a benefits navigation startup for LGBTQ+ employees, recently landed two big clients, Walmart and State Farm. CEO Colin Quinn explained the company’s journey […]
From a recent article in NBER by Dunn et al. (2021): Observing the back-and-forth sequences of claims’ denials and resubmissions for past visits, we can […]
Unsurprisingly, high-deductible health plans lead to lower utilization of healthcare services. A study by Sandoval et al. (2021) use data from 2007-2019 from Switzerland to […]
Last fall, ICER published a white paper titled “Cornerstones of ‘Fair’ Drug Coverage: Appropriate Cost-Sharing and Utilization Management Policies for Pharmaceuticals.” To paraphrase, ICER’s goal […]
In recent decades, drug prices have risen. To offset this cost, pharmacy benefit managers have negotiated increasingly large rebates which drug manufacturers pay health insurers. […]
How do you get your prescription drugs? For most people, it involves going to your local pharmacy and picking up your pills. But what if […]
This is the question posed by a recent article by Lopata et al. (2021). The authors surveyed 26 payers (e.g., leaders of national, regional, local, […]
Just over a year ago, hi.health launched an app that takes the legwork out of submitting reimbursement claims to private health insurers. Now, the startup […]
Uninsured Older Americans Have Worse Cancer Outcomes than Medicare Beneficiaries Study shows a dose-response effect on survival that varies by the robustness of insurance coverage. […]
A paper by Lurie et al. (2021) provides the answer. They reach four conclusions from their analysis: First, the actual penalty paid per uninsured month […]
Why don’t people eligible for health insurance exchange plans (i.e., Obamacare plans) enroll? One reason could be that they value the health insurance benefit at […]
Getting sick creates risk over two dimensions. First, you risk getting sick which of course decreases your utility. Second, getting sick impacts you financially as […]
Value-based contracts covering the reimbursement of drugs and medical devices are slowly gaining acceptance. A panel at the MedCity News INVEST conference discussed the challenges […]
Unless the Supreme Court strikes down the ACA, it will remain in place for the foreseeable future and will see expansion.
A Surgical Emergency Exposes the Crisis of the Young and Uninsured When a patient looked anxious before emergency surgery, it turned out he was worried […]
Dr. John Frownfelter, MD, FACP, Chief Medical Officer at Jvion In 1852, Mercy Hospital & Medical Center opened as Chicago’s first chartered hospital. In May, […]
The first quarter of 2021 has been one of investor optimism as the vaccine rollout continues ahead of expectations and economic activity begins to accelerate in […]
David Talby, CTO, John Snow Labs Heart disease is the leading cause of death for people of most racial and ethnic groups in the United […]
Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access […]
Why Infertility Treatments Should Be Covered by Insurance Although it’s improving, most insurance coverage for infertility treatment doesn’t match that provided for other conditions. Here’s […]
Paul Banco, CEO of etherFAX To support the sudden increase in test results and medical records being transmitted during the pandemic, hospitals, laboratories, and pharmacies […]
After a scathing report from short-seller Hindenburg claiming that Clover faced a False Claims Act investigation, the insurance startup’s stock plummeted. Clover went public last […]
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation We’re now in a new year and new presidential administration. At least three companies are producing […]
Paula Muto, MD, FACSFounder and CEO, UBERDOC, Inc. We are at a watershed moment. The COVID-19 pandemic has forced us to reevaluate our priorities both […]
The Medicare Coverage Gap: What Will the Donut Hole Look Like in 2021? The Medicare coverage gap is present in most Medicare plans,but it’s been […]
Mike McSherry, CEO & Co-founder of Xealth HIT Consultant sat down with Mike McSherry, CEO, and co-founder of Seattle-based digital prescription platform Xealth to discuss […]
Lillian Phelps, Sr. Director of Product Management, Availity As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality […]
Private medical insurance company Further Group has ramped up its presence in digital healthcare by merging with Trustedoctor, a startup that puts patients in contact […]
What You Should Know: – Regence and MultiCare ink first-in-the-nation value-based care partnership to deliver improved health outcomes at lower costs. Health insurance provider Regence […]
Verily is planning “significant and focused growth” in 2021 after closing a $700 million funding round from investors including its parent company, and Google holding […]
What Will Healthcare Look Like in a Post-COVID-19 World? (Part 1) Notes from HLTH VRTL 2020: The future of healthcare post-COVID and anticipated impacts of […]
In the 2020 election, Americans nationwide cast their ballots with two major issues on their minds – the economy and coronavirus. Health care specific concerns […]
Don Godbee Don Godbee, Mobile Solutions Architect at Stratix Don Godbee Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid […]
Healthcare agency, consultancy and digital health group, Healthware, has announced the acquisition of Finland-based digital service development and creative agency Make Helsinki. Healthware strengthens its […]
In the Face of a Medicaid Tsunami, Telehealth is More Important Than Ever Telehealth utilization under Medicaid surged during the pandemic providing needed services to […]
Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division Healthcare can achieve optimum efficiency when patients are at the center of care. When patients […]
Margarita Alegría, PhD, Chief of the Disparities Research Unit at Massachusetts General Hospital American businesses and their leadership are at a crossroads. COVID-19 has forced […]
By ROSEMARIE DAY and NIKO LEHMAN-WHITE One of the most important responsibilities of the American government is to protect its citizens from harmful industry practices, […]
Michael A Greely, Co-Founder & General Partner at Flare Capital Partners This will be ugly and sad. Racism has cost this country $16 trillion over […]
University of Virginia Health System (UVA Health) has gone after patients’ homes to pay for medical bills. Kaiser Health News reports: UVA Health and other […]
CVS Health/Aetna Responds to the Maternal Health Crisis During COVID While not a solution to the maternal health crisis, good communication can help expectant patients […]
Starship, a startup making Health Savings Accounts easier to use, has seen an influx of users since the start of the pandemic. In the first […]
Prior authorization is a requirement that health plans require physicians to obtain plan approval in order to prescribe a patient a given medication. Prior authorizations […]
What You Should Know: – NVIDIA and Massachusetts General Brigham Hospital researchers develop an AI model that determines whether a person showing up in the […]
The plans will include zero-dollar premiums and will give patients access to free primary care visits, dental exams and lab tests at Walmart Health centers […]
What You Should Know: – Anthem extends the use of doc.ai’s platform and portfolio of privacy-first technologies and artificial intelligence software services to drive the […]
Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance […]
Alphabet’s healthcare subsidiary, Verily, will partner with Swiss Re Corporate Solutions to create a new stop-loss insurance company. The new entity, called Coefficient, will use […]
What You Should Know: – Alphabet’s Verily has established a new subsidiary, Coefficient, with a mission to create value by combining innovative health technology solutions […]
By KEN TERRY In the strangest healthcare business story of 2020, the major health insurance companies are thriving despite—or because of—the pandemic. As the second […]
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation In the late 1940s, the United Kingdom was busily reassembling country and what remained of the […]
Max Mancini, CTO at Collective Health What You Should Know: – Collective Health appoints Max Mancini as its new Chief Technology Officer. – Mancini, who […]
By KIM BELLARD I’ve been covered by private insurance my entire life. Even more telling, I worked in the health insurance industry for — gasp! […]
New Long-Term Care Benefits Added to Medicare Advantage Plans Medicare’s coverage of long-term care is limited, but new benefits added to some Medicare Advantage plans […]
David Shelton, PatientMatters CEO In the past few months, the COVID-19 pandemic has shaken societies, economies, and human wellbeing to the core. While protecting public […]
UnitedHealth Group saw its earnings nearly double to $6.6 billion during the second quarter, as fewer patients sought out appointments or non-essential procedures due to […]
– Walgreens will invest $1 billion in equity and convertible debt in VillageMD to open 500 physician-led primary care clinics in more than 30 U.S. […]
Walmart quietly launched a new health insurance business. The company, called Walmart Insurance, was filed with the Arkansas Secretary of State last month.
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