health insurance

New report: To drive up profits, hospitals continue unnecessary medicine mark-ups, burdening patients, employers and the health system

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 – depending on whether they were administered at a hospital outpatient department or physician’s office. Not surprisingly, EBRI found employers and plans paid hospitals significantly more than physicians for the …

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Health Insurance is a Stumbling Block in Many Patients’ Thinking

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 at the cost of his medications and our office visit charges. His car cost a lot of money and I know that authorized Mercedes dealers charge around $140/hour for their …

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Biden Should Extend a “Public Option” as a Message to “Health Care Royalists”

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 about Rep. Eric Swalwell riding shirtless on a camel in Qatar streaming relentlessly, Americans can be excused if they missed a substantive and historic news event last week. On Friday, …

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How a benefits navigation startup for LGBTQ employees won over big companies

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 so far and why more benefits leaders are paying attention to LGBTQ+ employees’ health needs. 

How do claim denials affect physician willingness to accept Medicaid patients?

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 estimate physicians’ costs of haggling with insurers to collect payments. Combining these costs with the revenue never collected, we estimate that physicians lose 17% of Medicaid revenue to billing problems, …

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Demand curves still slope downwards

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 show that this is the case. Participants with high-deductible plans reported forgoing health care more frequently than those with low-deductible plans (331 [13.5%] vs 591 [8.7%]). In adjusted analysis, higher-deductible …

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How ICER will conduct it’s “Barriers to Fair Access” Assessment

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 is to limit access restrictions (e.g., cost sharing, coverage limitations, prescriber restrictions, step therapy) when a drug is deemed to be cost effective. How will they do this? Their Barriers …

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Rebates and out-of-pocket cost

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. PBMs argue that rebates help keep net drug prices down. Manufacturers argue that PBMs want higher list prices so they can negotiate larger rebates. Patients may not like rebates if …

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Which strategies are payers and employers using to cover orphan drugs?

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, Medicaid, and Medicare plans; payer components of integrated delivery systems; and pharmacy benefit managers (PBMs) and 11 employers (e.g., large employers, employee benefit consultants, employer coalitions). Respondents were informed that …

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Healthcare bills to pay? Let hi.health pick up the tab

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 has taken another leap forward, settling users bills immediately.  Fredrik Debong The addition to the hi.health app acts as a digital health expense account, according to the company’s co-founder and …

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Did the individual mandate work?

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 is less than half the statutory amount. Second, nonetheless, we find visually clear and statistically significant responses to both extensive margin exposure to the mandate and to marginal increases in …

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Will health plan outreach increase take-up by enrollees that are healthier or sicker?

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 less than the cost. Another reason could be behavioral frictions; informational search costs and psychological frictions are costly and may preclude enrollment even when benefits are more than cost. For …

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Health Insurance and Investment Risk

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 (i) medical procedures are often expensive and (ii) if you can’t work due to your illness your income may fall. With respect to financial risk, health insurance may provide a …

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Like it or not, value-based contracting is coming for drugs and medical devices

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 and opportunities for these contracts, which aim to improve patient outcomes and control the cost of care.

What Will It Take for Hospitals to Survive the Pandemic?

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, it will close, leaving residents of the surrounding South Side community — poor and mostly people of color — without a place to see a doctor. And it isn’t the …

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Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity

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 response.  Within the Health IT industry, the already strong investment and M&A trends seen in 2020 have only accelerated.  Over the course of the quarter, we observed $7 billion in private …

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How NLP Can Uncover Social Determinants of Heart Disease

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 States. Cardiovascular disease-related deaths—which occur every 36 seconds—cost our country about $219 billion each year, according to the Centers for Disease Control and Prevention (CDC). People with poor cardiovascular health …

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Q&A: optimizing reimbursements by capturing missed coverage

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 with automation As the vaccine management process continues to ramp up, providers are focused on how to administer the vaccine to as many people as quickly and efficiently as possible. …

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Best Practices to Ensure Telehealth Security and Protect Patient Data

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 implemented additional devices and remote connections into their networks. After the Office for Civil Rights (OCR) lifted penalties around telehealth to expand care options amid the crisis, new platforms were …

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Short seller targets insurance startup Clover in scathing report

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 month after merging with a special-purpose acquisition company under billionaire investor Chamath Palihapitiya.  

Evaluating COVID-19’s Behavioral Health Impact on the Economy

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 effective COVID-19 vaccines, which are being administered to healthcare workers, teachers, and the elderly. By summer, hopefully a large majority of the population in most countries will be vaccinated. From …

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A New System to Fit A New Economy: How Healthcare Can Recover From COVID-19

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 economically and with regard to public health. Living with a healthcare system that was created in response to an emergency measure during World War II, US consumers have struggled for …

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Xealth’s CEO Shares Impact of Digital Health in 2020 and What’s Ahead in 2021

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 digital health lessons learned in 2020 and what we can expect in 2021. As Xealth’s CEO, Mike also works with Duke Health, UPMC, Atrium Health, and The Froedtert & the …

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4 Quick Tips for Getting COVID-19 Claims Paid Promptly

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 for treating COVID-19 patients, stretching their resources to the breaking point.  We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, …

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Further, Trustedoctor merge to provide ‘borderless’ healthcare

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 with medical professionals. Further – which was rebranded from BDU International last year – specialises in providing cross-border health insurance to people across Europe, the Middle East, Africa and Asia, …

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Regence, MultiCare Health System to Deploy HL7 Da Vinci Member Attribution List for Value-Based Care Arrangements

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 and MultiCare Health System, an independent accountable care organization (ACO) have partnered to deploy a first-in-the-nation value-based model that delivers better health outcomes to members at lower costs while simplifying …

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Google’s Verily eyes 2021 growth after £700m funding round

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 firm, Alphabet. The capital injection will support wide-ranging plans for the new year that include several life sciences programmes in surgery, pathology and immunology, which would add to the digital …

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Election insights: Voter priorities in the states

In the 2020 election, Americans nationwide cast their ballots with two major issues on their minds – the economy and coronavirus. Health care specific concerns centered on pre-existing conditions protections and rising out-of-pocket costs exacerbated by declining coverage. But how do these trends compare at the state level?

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense

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 response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it is. Indeed, virtual visits to care providers and remote patient …

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Healthware Group announces acquisition of Make Helsinki

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 geographical coverage with the creation of a hub dedicated to the Nordics and Baltics region The deal combines Healthware’s consulting, full-service agency and digital health capabilities with Make Helsinki’s additional …

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COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts

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 have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the …

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COVID-19 and Racial Disparities: Transforming the Health of Businesses

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 us all to re-evaluate how we work and live, while the current protest movements have placed a spotlight on the systemic injustices non-white workers face both in and out of …

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Election Issue Spotlight: “Junk” Insurance Makes a Pandemic Even Worse

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, from lead poisoning to dangerous pharmaceuticals to financial meltdowns. Its record is far from perfect, but government regulators usually act in good faith and in turn earn the trust of …

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COVID-19 Pandemic Further Exposes Systemic Racism…

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 the last twenty years according to a recent Citigroup report. Much of this loss ($13 trillion) was attributed to discriminatory lending practices and the 6.1 million fewer jobs created as a …

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Health systems seize patients home equity to pay medical bills

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 medical systems rarely force the sale of a home to claim money. Instead, they wait for families to refinance or sell, taking their cut at the settlement table. But with …

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The problem with prior authorization

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 may be put in place to insure medications are not used inappropriately or for payers to try to reduce cost. While prior authorization may help save money, delays in the …

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NVIDIA Develops AI Model to Accurately Predict Oxygen Needs for COVID-19 Patients

What You Should Know: – NVIDIA and Massachusetts General Brigham Hospital researchers develop an AI model that determines whether a person showing up in the emergency room with COVID-19 symptoms will need supplemental oxygen hours or even days after an initial exam. – The ultimate goal of this model is to predict the likelihood that …

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Anthem Expands Relationship with doc.ai to Power Digital Health Offerings

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 personalization of Anthem’s digital assets and create improved value for users. – doc.ai’s product offerings are deployed on its cloud-agnostic and zero-trust infrastructure that lets clients like Anthem launch products …

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Finding unidentified coverage without a Social Security Number (SSN)

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 or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve collections, providers are often tasked with finding this information on …

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Verily Forms New Subsidiary Focused on Employer Stop-Loss Through Precision Risk

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 with new insurance and payment models. Verily is the majority shareholder and Swiss Re Corporate Solutions, an established player in the employer stop-loss market, has a minority stake in the …

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Health Insurers Ride High for Now, But Watch What’s Coming Next

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 quarter reports of United, Anthem, Cigna and other insurers reveal, their COVID-19-related costs were outweighed by the sharp drop in claims for other healthcare services. As a result, the second …

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COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever

Irv Lichtenwald, President & CEO of Medsphere Systems Corporation In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity …

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Collective Health Appoints Max Mancini as New Chief Technology Officer

Max Mancini, CTO at Collective Health What You Should Know: – Collective Health appoints Max Mancini as its new Chief Technology Officer. – Mancini, who previously held senior roles at Apple and eBay, will lead the company’s exceptional engineering team- overseeing the architecture, design and scaling of Collective Health’s core platform and suite of products …

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COVID-19: 4 Essential Patient Payment Strategy Components to Accelerate Cash Flow

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 health and welfare are top priorities for hospitals, the harsh reality is that it takes cash to keep the doors open and serve patients effectively. Revenue is down significantly as …

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Walgreens to Invest $1B in VillageMD to Open 500 to 700 Full-Service Doctor Offices

– 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. markets in the next five years. – VillageMD and Walgreens also recently announced the availability of Village Medical telehealth providers on Walgreens Find Care™, which is an online platform that …

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