Whether you refer to it as Reference Based Pricing, Medicare Reference, Cost Plus or something else, the important thing is to understand what it is and why it’s being used to lower health plan costs. Health plans with reference based pricing provide high quality coverage at a lower cost by using Medicare fee schedules as [...]
This article was published on March 25, 2020 BenefitsPro.com, written by Katie Kuehner-Hebert. Photo source BenefitsPro.com. Covered California's actuarial/policy brief recommends that Congress consider three actions now to mitigate impact. Congress needs to mitigate what could be substantial cost increases for both insurers and their members due to the COVID-19 pandemic, warns Covered California, the [...]
From hospitals to insurers, you’ve probably heard many say that the goal is to provide the right healthcare, at the right time, in the right place. When it comes to the infusion of high-priced specialty drugs, location can make a huge difference. As an example, the variance in the cost of hospital-administered multiple sclerosis drugs [...]
When Alexa Kasdan's sore throat lingered for more than a week, she went to her doctor. The doctor sent her throat swab and blood draw to an out-of-network lab for sophisticated DNA tests, resulting in a $28,395.50 bill. (Shelby Knowles for Kaiser Health News). This article was published on December 23, 2019 on NPR, written [...]
In late June, President Trump signed an executive order directing HHS to develop rules requiring hospitals to publish clear and understandable pricing that reflects what people will actually pay for services. HHS Secretary Alex Azar added that the order should also make certain that providers and insurers provide patients with information about potential out-of-pocket costs [...]
The President’s Executive Order Demands Healthcare Cost Transparency We have long chronicled the huge price swings that often exist among healthcare providers in the same locales. To combat this situation and help patients find low cost, high-quality care, the President recently signed an executive order directing HHS to develop rules requiring hospitals to publish clear [...]
Researchers hope the study will give private payors a better grasp of what health care costs are, and allow them to compare prices within a state and across states. (Photo: Shutterstock) This article was published on May 13, 2019 on BenefitsPro written by Scott Wooldridge. Prices range from 150 percent of Medicare prices [...]
According to a public-private partnership launched by HHS, the percentage of U.S. healthcare payments tied to value-based care rose to 34% in 2017, a 23% increase since 2015. Fee-for-service Medicare data and data from 61 health plans and 3 fee-for-service Medicaid states with spending tied to shared savings, shared risk, population-based payments and bundled payments [...]
If your plan isn’t managing eligibility at enrollment, you’re probably throwing money away! Managing eligibility in a self-funded environment can place a big burden on HR Directors, not only at enrollment, but throughout the year. Employee benefit elections, dependents and beneficiaries must be monitored consistently and then there are new hires and terminations to deal [...]
This article was published on March 13, 2019 on BenefitsPro written by Max Nisen. OptumRX, UnitedHealth's PBM, will mandate that all new employer health-plan clients pass the drug discounts it obtains directly to plan participants. The health-care policy environment is shifting in a dangerous way for insurance giants. A seemingly small change in how drugs [...]
