Dive into our latest case study on our blog, where Ahmed Marmoush, Francois de Brantes and Ria Shah explore how, despite their limitations, price transparency machine-readable files can be used to help employers and their members make more informed healthcare purchasing decisions. Using data from the MRFs, the case study compares how a UnitedHealthcare plan and a Blue Cross Blue Shield of Texas plan perform in the Dallas area. Through this analysis, you'll discover how, even with imperfections, MRFs can be leveraged to design cost-effective and accessible health plans. 📊 Read it here 👇
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Providers and health plans agree on value-based care obstacles but little else, according to new findings from Azara Healthcare and Sage Growth Partners. Learn more in this recent article from HealthLeaders https://lnkd.in/gTWEp52Z
VBC: Trust Low, Need For Data Exchange And Integration High
healthleadersmedia.com
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There is still time to participate in Alliant’s Healthcare Benefits Survey! The survey is open until March 28 to U.S.-based healthcare organizations and covers topics like medical, dental, and vision benefits; paid-time off and leave; well-being; pharmacy; mental health; return-to-work strategies; and more. Following the survey’s close and analysis, participants receive a detailed data report available only to participating companies. Obtain insider information that will help you drive the next phase of your benefits strategy and see how your benefits offerings compare to others in the healthcare industry. https://bit.ly/3STfnLb #AlliantInsurance #employeebenefits #humanresources #totalrewards #healthcareindustry
Take part in Alliant’s 2024 survey.
alliant.com
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Excited to share Nick Soman's recent Q&A with Dave Chase, Health Rosetta-discovering archaeologist! 🏥💡 Dave's insights on transforming healthcare are truly inspiring. A few key takeaways: 1️⃣ Health Rosetta has improved benefits for thousands of employers, eliminating high deductibles and co-pays. 2️⃣ They're reinvesting $1.5 trillion in wasted healthcare costs into social determinants of health. 3️⃣ Dave emphasizes building new models that make existing ones obsolete, rather than fighting the current system. 4️⃣ He dispels the myth that healthcare is inherently expensive, pointing out that actual clinical services only account for about 25% of healthcare spending. Dave's passion for creating a more equitable and efficient healthcare system is contagious. His work proves that positive change in healthcare is not only possible but happening right now. Read the full interview to learn more about Dave's journey, the impact of Health Rosetta, and his vision for the future of healthcare in the US: https://lnkd.in/gH_HDJxR #HealthcareInnovation #HealthRosetta #LeadershipInsights #HealthcareTrends
Healthcare Rebel Alliance: Q&A with Dave Chase, CEO of Health Rosetta | Decent
decent.com
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Consultant | Healthcare Actuary | Transparency Czar | Grill Master | Transplanted Yinzer | Empty Nester
Over the past few days, I dove into RAND 5.0; I’m really into data that sheds light on healthcare prices, and there’s some really interesting stuff here. Consistent with prior studies, 5.0 highlights that commercial reimbursements are materially higher than governmental programs, there’s a lot of price disparity both within markets and across markets, and – based on the quality measures cited in the report – there’s not a clear linkage between price and quality. One thing that surprised me a bit was how much the report leaned into employers using these results to make benefit plan decisions. Directionally, I think there’s excellent research and information here, but there can be some pretty big gaps between directional and actionable. There’s certainly no perfect dataset to support these kind of decisions, but some considerations specific to an employer are: + What health plans and networks are represented in the data? + How much have provider contracts changed from 2022 (the study baseline) to current? + Is this data applicable to my specific population / can we extrapolate? As a whole, the study indicates it covers about 6% of the private market, but some states (e.g., Texas) appear to cover <1% of the private market. + Do I care about the prices I pay relative to Medicare, or do I care about the prices I pay? + What is the best measure of provider quality? Directionally, it’s valuable to know, in aggregate, who the high-cost providers are in a given market. But to make informed decisions, it’s critical to understand TPA-specific and network-specific contracts at those providers, and it’s also really important to understand the actual price differential – it doesn’t matter to my benefits budget if Medicare pays a higher reimbursement to a Teaching Hospital. We are still in the very, very early stages of being able to use hospital (HPT) and payer (TiC) price transparency data to make actionable benefits program decisions; however, in theory, the HPT/TiC data do allow for this deeper level of analysis (by health plan, by network, actual price comparisons), though you also need to ask the hard questions about data quality and data reliability. And we will continue to have an ongoing challenge of determining the best approach to assess the quality of healthcare. What do you think employers can do with RAND / HPT / TiC? #healthcare #pricetransparency #employeebenefits
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Agree that RAND is directional but is vital in that capacity. There are still too many employers buying health care and too many people making policy that don't understand the significant price variations that exist between hospitals. RAND is the most comprehensive study to date that illustrates this at a high level. The study also shows no correlation between cost and quality which is critical to understand. My hope is that an employer looking at RAND will think HEY!, maybe we should empower ourselves to shop for care. There are ways to gain access to ACTIONABLE data once they make that decision and take the first steps forward. It starts with self-funding and choosing the right TPA and network partners. The cost savings are dramatic and positive when employers take this path. I also hope policymakers that take the time to understand RAND will start to ask the right questions about the cost burden that is put on employers and employees, because we need more than RAND, HPT and TiC as they exist today to get to the point where everyone who pays for health care fully understands the prices. Thanks for the soapbox opportunity!
Consultant | Healthcare Actuary | Transparency Czar | Grill Master | Transplanted Yinzer | Empty Nester
Over the past few days, I dove into RAND 5.0; I’m really into data that sheds light on healthcare prices, and there’s some really interesting stuff here. Consistent with prior studies, 5.0 highlights that commercial reimbursements are materially higher than governmental programs, there’s a lot of price disparity both within markets and across markets, and – based on the quality measures cited in the report – there’s not a clear linkage between price and quality. One thing that surprised me a bit was how much the report leaned into employers using these results to make benefit plan decisions. Directionally, I think there’s excellent research and information here, but there can be some pretty big gaps between directional and actionable. There’s certainly no perfect dataset to support these kind of decisions, but some considerations specific to an employer are: + What health plans and networks are represented in the data? + How much have provider contracts changed from 2022 (the study baseline) to current? + Is this data applicable to my specific population / can we extrapolate? As a whole, the study indicates it covers about 6% of the private market, but some states (e.g., Texas) appear to cover <1% of the private market. + Do I care about the prices I pay relative to Medicare, or do I care about the prices I pay? + What is the best measure of provider quality? Directionally, it’s valuable to know, in aggregate, who the high-cost providers are in a given market. But to make informed decisions, it’s critical to understand TPA-specific and network-specific contracts at those providers, and it’s also really important to understand the actual price differential – it doesn’t matter to my benefits budget if Medicare pays a higher reimbursement to a Teaching Hospital. We are still in the very, very early stages of being able to use hospital (HPT) and payer (TiC) price transparency data to make actionable benefits program decisions; however, in theory, the HPT/TiC data do allow for this deeper level of analysis (by health plan, by network, actual price comparisons), though you also need to ask the hard questions about data quality and data reliability. And we will continue to have an ongoing challenge of determining the best approach to assess the quality of healthcare. What do you think employers can do with RAND / HPT / TiC? #healthcare #pricetransparency #employeebenefits
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Empower your workforce with healthcare navigation tools that drive cost efficiency and improve care quality. Our latest blog post explores how these tools help employees find high-value care, reducing healthcare costs and enhancing health outcomes. 🩺 https://hubs.ly/Q02FGw_90 #HealthcareInnovation #EmployeeWellness #HealthcareNavigation
Navigating Cost Efficiency and Quality in Healthcare
blog.healthcarebluebook.com
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As we enter the season when employers and HR leaders are evaluating and making final decisions on partners to enhance their healthcare strategies, I'm reminded of this insightful WTW article Drew Hodgson wrote last summer. He emphasizes that sticking to the status quo is too risky, and highlights innovative healthcare strategies that reduce costs and improve outcomes, such as curated-broad-network approaches and concierge/navigation services. At Sharecare, we are proud to collaborate with our clients to provide top-notch concierge/navigation services. We take it a step further by offering solutions that not only support those with emerging and high health risks but also help healthy individuals maintain their health. A big thank you to partners like Lennar, who have chosen to break away from the status quo and implement our solution. The results speak for themselves: - 20% reduction in health risk factors among associates while keeping healthcare costs stable - 11.4% improvement in preventative care - 9.1% decrease in lifestyle-related risks Together, we are making significant strides in enhancing health outcomes and controlling costs.
The status quo is too risky – Which healthcare strategies can reduce costs and improve outcomes?
wtwco.com
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As the Midwest winter unfolds, bringing its characteristic gray skies, we've found a silver lining in the keen interest from employers in ImagineMD's approach to advanced primary care. This enthusiasm serves as a welcome distraction and highlights a positive shift in the healthcare market towards primary care models that not only promise but deliver better care at more affordable costs. This shift, driven by innovative benefits consultants, is reshaping expectations and outcomes in healthcare. Contrary to skepticism, models like reference-based pricing are making a significant impact here. Together with our partners at ClaimDOC and Connor & Gallagher OneSource we're consistently demonstrating that such approaches are not only viable, but also highly effective in reducing healthcare costs. The success stories we're accumulating are a testament to the power of innovative healthcare solutions. For employers who are grappling with the relentless rise in healthcare expenses and seeking a way out, we offer a proven solution. Our model is designed to address and mitigate these challenges head-on. If the increasing cost of healthcare is a concern for you, we invite you to reach out. Let us show you how ImagineMD's model can make a difference for your organization.
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At Unified Health Plan, we recognize the immense challenges healthcare providers face in delivering optimal patient care. That's why we proudly offer our provider partners the education and resources they need to excel in their practice. By joining our esteemed ProviDrs Care Network, you not only gain access to vital resources, but also unlock a world of benefits: 🟡 Stay Informed: Access manuals, newsletters, and webinars to stay up-to-date on the latest industry trends and policy changes. 🟡 Navigate Claims with Ease: Receive expert assistance with claims, disputes, and appeals, ensuring a smooth administrative process. 🟡 Compliance Made Simple: Stay ahead of state and federal regulations without the hassle, so you can focus on what matters most—your patients. 🟡 Discover Self-Serve Solutions: Our self-guided service portal empowers you to find answers and solutions independently, on your schedule. In today's dynamic healthcare landscape, easy access to health plan resources is of paramount importance. Join the ProviDrs Care Network and take the first step towards delivering the highest standard of care to your patients. Contact us today to learn more about the benefits of joining our network and how we can support your practice. We're here to ensure your success as a healthcare provider. 🌐 https://lnkd.in/g-UQh3_n 📲 (800) 259-8330 💌 sales@unifiedhealthplan.net #unifiedhealthplan #healthcareplans #healthbenefits #grouphealthcareplans #employeebenefits #employeehealthcare #employeewellness #healthcareproviders #healthplanresources #patientcare #healthcareresources #healthcareaccess
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“Employers are frustrated right now because they’re not seeing the ROI for the amount of money they’re putting into their health benefit plans. Now that prices are beginning to be exposed, there’s a lot of opportunities to steer employees to the higher-value providers.” Our Chief Research Officer discusses how employers are best positioned to demand value for money from the U.S. #healthcare system with Managed Healthcare Executive. ⤵️ https://hubs.ly/Q02TrDCH0
Trilliant Report Finds the Money Spent on Healthcare Doesn’t Provide Value
managedhealthcareexecutive.com
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