Fierce Healthcare’s Post

In the healthcare landscape of 2024, health insurers are strategically navigating a transformative path, as outlined in Kelsey Waddill’s insightful article for HealthPayerIntelligence. The focus is fortifying health equity, adopting advocacy solutions for seamless navigation, and forming deeper partnerships with employers to address rising healthcare costs. I enjoyed the strategies highlighted by Waddill that underscore dedication to innovation and enhancing the overall healthcare experience. https://bit.ly/3NOHlGm #HealthPlans #Medicare

Magicians don't use smoke and mirrors as well as lobbyists for PBMs do! Despite it's very awesome title of the bill = "Lower Costs, More Transparency Act". It's actually is a bad thing for those of us who want to help consumers lower Rx costs! Why? "The pending Lower Costs, More Transparency Act would erode these pillars by expanding the use of price estimates for hospitals, eliminating billing codes and other identifiers for health insurers, and enabling third-party administrators, insurers and provider networks to restrict access to critical claims information that employers need" 🤯🤢🤮 Scripta Insights Ashley Moyer Ferrin Williams, PharmD MBA #drugpricing #healthcarecosts https://lnkd.in/euU_Bt4t

Not Only Health Care Providers Are Audited. Read the blog!

Health care. We all have it, don’t we? The issue of healthcare is on the minds of the majority of voters in the USA. Why? -Despite what some might think, healthcare is a very complex issue. -Its expensive! In just the past two years, this nation’s spending grew over 4%. In 2022, we spent $4.5 T on healthcare. Over half of that money is spent on hospital care (30.4%), physician services (14.5%), and prescription drugs (9.1%). With all of that money spent, you would think we have the best healthcare system worldwide…nope. -When measuring what it takes to have a superior healthcare system (ex equitable, efficient, etc), the US is performing poorly. Voters are laser-focused on this issue since high quality healthcare can help to improve a person’s quality of life and prevent diseases. Be an informed voter and consider the candidates’ positions on this vital issue. It’s a matter of life and death. #healthcare #womenshealth #votehealth #informedvoter https://lnkd.in/ga4jW_Vg

Excellent feature in The Colorado Sun using CO APCD data to track the cost of health care in CO - the positive impacts of the ACA on affordability. (My job is really cool) "How much more expensive has health care become in Colorado? There’s a good amount of data on this because the aforementioned Center for Improving Value in Health Care maintains what is known as an all-payer claims database for Colorado — that is, it oversees a massive collection of medical bills that can be used to estimate health care spending in the state." https://lnkd.in/giTv4dFb

Brokers understandably focus on those buying health plans, but an employer is impacted when their employees face mounting medical debt whether covered by a plan or not. Savvy employers are choosing to arm themselves to defend their employees from outrageous hospital bills with the unparalleled patient advocacy team at CareGuide Advocates. At CGA, we're plan-agnostic: hospitalization bills with errors and overcharges are the target of our negotiation and cost reduction efforts whether the employee has insurance or not, and even if the claim is denied. Does your benefits package defend like this? 🤔

The recent class action lawsuit filed by a Mayo Clinic employee, marking the second lawsuit of its kind in as many months, spotlights an increasingly pressing issue for self-insured employers: the rising cost of healthcare. This trend isn't just a wake-up call; it's a loud siren for companies managing their own health insurance plans. We're potentially looking at a pivotal moment where self-insured employers might have to fundamentally rethink their healthcare strategies. Firstly, it's critical for self-insured employers to closely examine their healthcare cost structures and the partnerships they rely on, especially with pharmacy benefit managers (PBMs). Transparency in how costs are determined and where the money goes is paramount. Without this clarity, employers can find themselves vulnerable to unforeseen financial pressures, as seen in these lawsuits. Moreover, this situation underscores the importance of adopting a fiduciary standard of care in managing health plans. Employers have a responsibility to ensure that their employees' health benefits are managed with the utmost care and diligence, prioritizing cost efficiency without compromising on quality of care. This approach not only mitigates the risk of litigation but also fosters a healthier, more satisfied workforce.

The recent class action lawsuit filed by a Mayo Clinic employee, marking the second lawsuit of its kind in as many months, spotlights an increasingly pressing issue for self-insured employers: the rising cost of healthcare. This trend isn't just a wake-up call; it's a loud siren for companies managing their own health insurance plans. We're potentially looking at a pivotal moment where self-insured employers might have to fundamentally rethink their healthcare strategies. Firstly, it's critical for self-insured employers to closely examine their healthcare cost structures and the partnerships they rely on, especially with pharmacy benefit managers (PBMs). Transparency in how costs are determined and where the money goes is paramount. Without this clarity, employers can find themselves vulnerable to unforeseen financial pressures, as seen in these lawsuits. Moreover, this situation underscores the importance of adopting a fiduciary standard of care in managing health plans. Employers have a responsibility to ensure that their employees' health benefits are managed with the utmost care and diligence, prioritizing cost efficiency without compromising on quality of care. This approach not only mitigates the risk of litigation but also fosters a healthier, more satisfied workforce.

"Prior authorization" can be a triggering phrase for some doctors and patients, but the reality is that it's a necessary tool for keeping rising #HealthCare costs under control. When done properly, and as part of a well-run healthcare management program, #PriorAuthorization helps make sure that patients get the medicine they need, and that employers and employees are only paying necessary costs. We know how to run a PA program so that it works for all stakeholders. Want to know how we do it? Connect with us to find out. #EmployeeBenefits #EmployeeHealth #HealthcareManagement