Establishing site-neutral payments for outpatient services is a hot issue in Capitol Hill right now. Advocates say that such policy would lower healthcare costs, saving both patients and taxpayers money. Opponents say that it would put hospitals’ financial security at risk and jeopardize access to care.
Kevin Sayer would love to bring his company's Dexcom G7 continuous glucose monitor to more people and more quickly. But despite being CEO of a successful device company, he feels frustrated from time to time about how and what the U.S. health system will pay for.
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
We are on the edge of rapid innovation in psychiatry. Now is the time to break out of our silos and take advantage of the promise the future holds.
Walgreens is seeing “an enormous amount of demand” for injectable weight loss drugs, its president of U.S. healthcare said during the Reuters Total Health conference in Chicago. He declared that the healthcare industry needs to come up with a reimbursement model “that correctly compensates pharmacists and others” to administer these drugs. In his view, reimbursement hasn't caught up with the demand.
I invite insurance companies to engage in meaningful dialogue with urgent care providers to understand the challenges they face and explore fair reimbursement models that reflect the value they bring to patients.
New research predicts that healthcare costs will increase by 7% next year. The estimate is higher than the projected medical cost trends in 2022 and 2023 — which were 5.5% and 6.0%, respectively.
It’s clear that services like telehealth and remote patient monitoring have potential to provide value within the healthcare industry, but hospitals and digital health companies need to show payers clearer evidence of the outcomes these care modalities can produce in order to earn reimbursement, panelists argued during MedCity's INVEST conference.
Carbon went out of Anthem Blue Cross’ network March 17 after not coming to an agreement on reimbursement. The company took the dispute public in an April 29 blog post declaring the rate Anthem pays its providers as not a livable wage. These kinds of disputes between payers and providers happen frequently, though they're usually not as public, one expert said.
A panel discussion at the annual Abarca Forward conference in Puerto Rico last month sought to identify some of the innovative financial approaches that can be applied to managing the high price of novel therapies. Conversations also addressed what payers need for these financing models to be sustainable.
To address the burden faced by family caregivers across the country, Tomorrow Health CEO Vijay Kedar argues that the U.S. healthcare system should expand its reimbursement for the care they provide. Not only is caregiving physically and emotionally taxing, but it can also cause severe financial strain —many caregivers take time off work and spend their own money to support their loved ones’ care, he explained.
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Without the help of genomics specialists, it is hard for health plans to manage genomic benefits efficiently and effectively. Now is the time for health plans to evaluate their genomic benefits management programs to find the right expert guidance and utilization management support.
Researchers project that the U.S. healthcare industry will be short 2.1 million nurses by 2025. Including them in reimbursement models might be the most effective way to address nurses’ mass exodus from the profession, according to Rebecca Love, who is a nurse and the chief clinical officer of tech-enabled nurse staffing platform IntelyCare.
To get to the root of existing reimbursement problems, health plans should consider tackling genomic benefits management in a way that addresses test ordering and billing challenges.
The very first would be to reimburse virtual care the same way in-person care is reimbursed. And here are four other simple things the government can do now to get U.S. healthcare on the right track.
The reimbursement model for remote patient monitoring needs to evolve as it may be holding providers back from investing in these programs, according to panelists at the MedCity INVEST Digital Health conference. Key issues with the structure as it stands now include the fact that there are too many gray areas that result in claims denials.
