Kristen Casstevens

Time for quarterly earnings season: - Elevance Health (Anthem) - reports increased revenue despite loss in membership due to the increased PBM revenue from CarelonRx. - CVS Health - "PBM profits continue to outperform driven by Cordavis contribution and Specialty growth" - Cigna Healthcare - Quarter over quarter PBM membership was down and yet - 2Q Express Scripts by Evernorth profit was up 7% driven by 3% growth in the PBM - UnitedHealth - "In the first half of the year, revenues grew by nearly $14 billion with strong contributions from across the enterprise, led by double-digit growth in Optum" Employers these companies thank you for your continued support in helping them drive record profits. Elevance Health is particularly excited and bullish on the opportunity ahead of them to force employers to use CarelonRx. I recently heard that they have an internal terminology used by the underwriting team when clients ask for pass-through PBM pricing. They call it "tinted glass" and have various models or levels they provide based on how smart the client is and how hard they are pushing. Dealing with these companies is like going to Vegas. The house always wins. While legacy PBMs continue to extract money from employers across the country SmithRx continues to focus on saving money for our clients. You dont have to trust us. You can ask our clients or look at our google reviews (since every other PBM hides those too). #pharmacybenefits #employeebenefits #PBM Rich Hejny Taylor Rogers

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I highly recommend this series to help providers understand the shifts to succeed with value-based care. This episode of the Business of Primary Care emphasized the critical need for a culture shift - a change in mindset. To succeed, organizations need to care much more about what the patient is doing outside of the visit. This requires lower-level staff to proactively reach out to patients to influence their behavior. A digital communication platform is critical to scaling this change in a way that also contributes to staff and patient satisfaction. https://lnkd.in/gCQmae-E

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Effectively bridging the gap between healthcare provider (HCP) and direct-to-consumer (DTC) marketing silos is critical for advancing cohesive virtual care strategies. This article dives into tactics for aligning these traditionally separate channels, emphasizing the importance of integrated data insights to personalize messaging across all patient touchpoints. By breaking down these silos, healthcare organizations can offer a seamless, patient-centered experience that boosts engagement, adherence, and health outcomes. Explore the full article here for insights into building a unified approach: https://lnkd.in/eEy2yvQ2 Discover about how we're transforming virtual care: https://lnkd.in/e5swhDbQ 

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The info you need for nationwide interoperability: Our #QHIN Readiness Guide. Learn more about how Qualified Health Information Networks (QHINs) support intelligence sharing from coast to coast, no matter where the patient is—and get ready to connect. https://ow.ly/PhHY30sBSKJ

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Working on Centaur Data Platform has shown me just how powerful data can be in solving some of healthcare’s toughest challenges—like addressing disparities that leave certain populations behind. Super excited to share Health Chain’s upcoming webinar on Clinical Data Integration (CDI) and its role in reducing healthcare disparities, I’m proud of the work we’re doing with Centaur to support this mission. Through Centaur, we’re not just aggregating data—we’re enabling Payers to: ✅ Go beyond claims data: By curating and normalizing clinical data, Centaur helps create a complete view of member health, which is critical to revealing care gaps that traditional datasets miss. ✅ Expose hidden disparities: Our platform combines data from multiple sources to highlight discrepancies in diagnosis, preventive care, and treatment across diverse populations—data that can make all the difference in member outcomes. ✅ Integrate SDOH: Centaur makes it possible to analyze the social factors (income, education, access to care) that often drive these disparities, helping organizations take actionable steps toward more equitable care. This work is personal to me because I’ve seen firsthand how data can be the key to closing the care gap for underserved communities. 📅 Join us for the webinar, and learn how we’re leveraging CDI and Centaur to drive meaningful change in population health. #HealthcareDisparities #CentaurDataPlatform #PayerInnovation #ClinicalDataIntegration #SDOH #HealthChain #PopulationHealth

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If you're navigating the complexities of value-based care, this CMS Value-Based Care Toolkit is a must-have! It offers a concise, at-a-glance comparison of key CMS value-based payment models, including the Medicare Shared Savings Program and other active CMMI initiatives. Learn more: https://lnkd.in/ggfFua64 #ValueBasedCare #HealthLaw #CMS #HealthcareInnovation

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Fresh #HSA insights for all the #benefitsadmin folks out there! So proud of the team for their research, analysis, composition, and design of this thoughtful report. Check out four key insights from a recent HealthEquity study on how employer HSA strategies influence employee behavior! 💡 #HSA #BenefitsAdmin #EmployerBenefits #ContributionStrategy

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Got questions? Drug-GPT has answers. Discover how healthcare marketing agencies can harness AI insights to stay ahead, align strategy, and make every decision data-driven.👇📹 #DrugGPT #AI #HealthcareMarketing

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Got questions? Drug-GPT has answers. Discover how healthcare marketing agencies can harness AI insights to stay ahead, align strategy, and make every decision data-driven.👇📹 #DrugGPT #AI #HealthcareMarketing

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It's fast, it works and it has an antagonizingly good product name. Worth reading if denied claims are getting you down. Claim Scrubber enables healthcare organizations to comply with and meet price transparency rules by staying updated on coding variances. Users can also revise flagged claims, ensuring appropriate and accurate corrections are made with access to Experian Health's extensive commercial payer policies and content database. Claim scrubbing occurs within 2.7–3.0 seconds, ensuring speedy transaction processing that leads to faster reimbursements.

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Surescripts recently surveyed over 500 clinicians to learn what they see as the biggest pain points in #healthcare, and what could be done to resolve them. Check out the biggest trends and takeaways: https://ow.ly/rqmN30sFcJx

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Join us today at 2:00 PM ET for our webinar, "Cutting Through Prior Authorization Headaches: Strategies to Thrive," by Matt Bridge and Ryan Chapin. #PriorAuthorization #PriorAuth #RevenueCycle #PatientExperience #RevenueCycle #RevenueCycleManagement

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New on Podnosis: How are practice management companies meeting the evolving needs of healthcare providers? I talk with Practice Better's CEO Kim Walsh about how they prioritize value and the different approaches they take to best serve its customer base:

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In this week's blog, Jessica discusses how DRTV advertising during AEP can drive immediate action, engage Medicare-eligible audiences, and simplify complex information. Click the link below to learn more about how you can maximize your outreach efforts during this crucial window with DRTV! #AEP #advertising #marketing #modusdirect #DRTV

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John Talaga, Flywire's EVP & GM of Healthcare, emphasizes the critical role of financial care in patient well-being: "Financial care should be considered a vital piece of the continuum of care." Join us in reshaping the patient financial experience. Read more in the full Healthcare Financial Management Association (HFMA) report:  https://lnkd.in/eyi_iJi4 #healthcare #patientcare #HFMA

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Check out my first blog post at Vim!

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Collections optimization sounds like a marketing buzzword, but it's actually true to its name: it involves leveraging technology to simplify and accelerate the process of collecting payments from patients. These solutions screen, segment and monitor accounts for efficient payment collections, and it's especially impactful in mid-sized GP offices that need a consistent cash inflow to keep doors open and patient care moving. With healthcare costs rising, affordability is a growing concern for patients and providers. About half of US adults find it challenging to cover their healthcare costs; one in four report needing help paying for healthcare within the last year, as per a KFF survey. In addition, according to Experian Health's State of Claims 2024 survey, 77% of providers are moderate to extremely worried about patient payments. Time to optimize.

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