payer

Specialty Pharmacy Is No Longer Optional Infrastructure

The organizations that move now — with the right foundation and the right partners — will enter the next planning cycle with a specialty pharmacy that functions as a true strategic asset.

Debunked Episode 28: A Little More Transparency, A Little More Action

Debunked Podcast co-hosts Arundhati Parmar and Samir Batra discussed some of the takeaways from UnitedHealth Group’s press event, transparency, and pharma company Lilly’s efforts to hold hospitals accountable in the 340B drug discount program.

The Myth of Insurance Networks

How America's outdated insurance model is failing at its most important job

APIs in Healthcare – Magic in the Air

Picture each patient with a computational model of their health where each treatable parameter (like weight, blood pressure, heart rate, exercise, inflammation, and blood chemistry) serves both as a marker for diagnosis and as an opportunity for treatment.

Healthcare’s Next Frontier: Building a Fully Connected Experience

It comes down to two simple questions that every health plan should consider: “Are we a company that pays for services and manages risks? Or are we a company that delivers better health for our members?”

Analyzing the Medicare Advantage Terminations: Concerns, Drivers, and Solutions

Both providers and payers face challenges and understanding the requirements and needs of each stakeholder has the potential to lower the temperature of the current rhetoric.

Payers Are Putting Profit Over Patients with Denials and Prior Auth Policies, Hospitals Say

Hospitals are facing increasingly burdensome policies from commercial insurers, leading to problems with cash flow and patient safety. Hospital executives think federal regulators need to enact stricter policies that require payers to operate on faster timelines, as well as provide more transparency into their reasons for denying claims.

The Carbon/Anthem Blue Cross Spat Is Nothing New, Just More Public

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.

Panel Orders UnitedHealthcare to pay $10.8M for Allegedly Underpaying Physicians

The lawsuit is one of nine cases throughout the country that TeamHealth has brought against United for alleged underpayments. The other eight cases are still ongoing. 

Report: Provider, payer websites are go-to online resources for patients making care decisions

Healthcare consumers are increasingly turning to the internet to research their care options, and provider and payer websites are among their top choices for information, according to a new survey of 1,000 U.S. adults. Over half of the respondents said they would use a provider or payer website to search for a new doctor.

AMA report: U.S. has “highly concentrated” payer markets that stifle competition  

About 73% of health insurance markets are highly concentrated, and in 46% of markets, one insurer had a share of 50% or more, a new report from the American Medical Association shows. The report comes a few months after President Joe Biden directed federal agencies to ramp up oversight of healthcare consolidation.

CareFirst unveils virtual-first primary care practice

The practice, which initially will only be offered to CareFirst BCBS commercial members, provides an array of services, including preventive care, insurance navigation and behavioral and mental health services. Patients will be referred to in-person care with local providers when needed.

Insurer price transparency rule faces legal challenges: 4 takeaways

Two lawsuits, filed by the U.S. Chamber of Commerce and the Pharmaceutical Care Management Association, allege that portions of the price transparency rule governing insurers are unlawful and would drive up healthcare prices, contrary to the rule's stated aim.