Dharmaraj Nagarajan’s Post

🚨New Blog Post:🚨 The bipartisan momentum behind the Improving Seniors’ Timely Access to Care Act of 2024 marks a critical step forward in addressing a longstanding issue in healthcare: the inefficiencies of prior authorization. With broad support in both the House and Senate, this legislation aims to streamline and standardize prior authorization processes within Medicare Advantage, ensuring patients receive timely and necessary care. Why Prior Authorization Reform is Essential: Prior authorization, originally designed to promote cost-effective and appropriate care, has evolved into a burdensome and opaque process that often delays treatment and creates unnecessary hurdles for patients and healthcare organizations. The statistics speak for themselves*: ✅ 94% of physicians report that prior authorization delays patient care. ✅ 24% say it has caused serious adverse events. ✅ 95% find it a significant contributor to burnout. These inefficiencies directly impact patient outcomes, leading to treatment abandonment and worsening health conditions, while undermining the trust patients place in their healthcare providers and payers. At Agadia, we’ve long recognized the challenges posed by prior authorization and have developed cutting-edge solutions to address these pain points. Our technology is designed to streamline the prior authorization process for health plans, PBMs, hub service companies, specialty pharmacies, and drug manufacturers. Learn how Agadia’s solutions align with the bill’s priorities and can transform healthcare delivery. 📖 Read our blog to explore the impact of this legislation and how we’re helping health plans, PBMs, and more revolutionize prior authorization. 🔗 https://lnkd.in/eBeJjjHx #HealthcareInnovation #PriorAuthorization #Agadia #ImprovingAccessToCare #MedicareReform

Healthcare costs are projected to rise 8% for the Group market next year according to a new PwC analysis. As the medical cost trend continues upward, it's increasingly imperative to control healthcare costs while supporting members on the path towards better outcomes. See how The Clinic by Cleveland Clinic's virtual second opinions expand access to high-quality specialty care, generating savings and impact for members with chronic and complex conditions: https://lnkd.in/grGmUx_a #healthcarecosts #specialtycare #virtualsecondopinions

Why do you need a strong stop-loss partner? Healthcare spending in the U.S. is nearly double that of other wealthy nations, yet our outcomes often fall short. While prescription drug prices grab headlines, most of the extra dollars in U.S. healthcare go toward hospital and physician payments, alongside higher administrative costs. This disconnect highlights the need for innovative solutions to manage rising expenses while maintaining high-quality, cost-effective care. That’s where a trusted stop-loss partner comes in. At TPAC, we help bridge the gap with strategies that tackle healthcare spending head-on—empowering employers to control costs while ensuring their employees receive the care they deserve. Ready to rethink your approach to healthcare costs? Let’s work together to create smarter, more sustainable solutions. Contact us at [email protected] #CostContainment #HealthcareInnovation #StopLoss

📢 Excited to share that I had the opportunity to assist in writing an article featured in the Great Lakes Integrated Network IPA (GLIN IPA) Pharmacy Factor's November 2024 issue! The piece, titled "2025 Medicare Part D Updates for Health Care Providers," delves into the impactful changes coming to Medicare Part D, including: ✅ Elimination of the coverage gap ✅ Introduction of a $2,000 out-of-pocket spending cap ✅ New Manufacturer Discount Program and enhanced cost-sharing models These updates are set to make medications more affordable, improve access for seniors, and transform the healthcare landscape for both patients and providers. Check out the article for more details on how these changes may shape clinical practice and patient outcomes in the year ahead. 🌟 #Pharmacy #MedicarePartD #HealthcareInnovation #PatientCare #PharmacistLeadership

Health plan sponsors: What are the 2025 projected cost trends for medical, prescription drug, dental and vision plans? Register for our complimentary webinar on Wednesday, October 9 to see the results of our latest survey of managed care organizations, health insurers, PBMs and TPAs. You’ll hear from three Segal healthcare subject matter experts — Eric Miller, FSA, CERA, MAAA, Vice President and Consulting Actuary, Health Practice Leader, Jason Jossie, ASA MAAA, Vice President and Consulting Actuary and Matthew Nguyen, PharmD, MS, BCPS, GBA, Vice President and Consultant Healthcare Informatics Consultant — who will present key findings from the 2025 Segal Health Plan Cost Trend Survey, including the double-digit projected trend for outpatient prescription drugs and the top strategies plan sponsors are using this year to manage health plan costs, most of which focus on Rx coverage. They’ll also examine some of the key issues to consider when developing a custom cost-management strategy that maintains high-quality standards and access to healthcare services. To reserve your place, register now: https://lnkd.in/edJuku5P #healthplans #costtrends #healthcare #healthcosts #healthcostmanagement #healthcarestrategies

DecisionRx, Inc. and AmeriLife Group, LLC are joining forces to revolutionize medication management for Medicare patients.  DecisionRx's Medication Therapy Optimization (MTO) platform analyzes patient genetics, lifestyle, and clinical history to personalize prescriptions.     MTO has shown impressive results, including $3,600 annual healthcare cost reduction for Medicare patients. This collaboration aims to improve patient outcomes, reduce healthcare costs, and enhance the quality of life for Medicare beneficiaries across the U.S.     “AmeriLife is dedicated to helping people live longer, healthier lives, and collaborating with DecisionRx aligns well with this mission,” said Scotty Elliott, Chief Distribution Officer of Health for AmeriLife. “By integrating comprehensive medication review into our Medicare products, we can ensure our clients receive the most effective and personalized medication regimens, ultimately leading to patients who are more satisfied with their health plans and providers, and at a lower overall cost.”    Learn more: https://lnkd.in/ewbMaVKM.    #HealthcareInnovation #MedicareAdvantage #PersonalizedMedicine #ValueBasedCare

Imagine this scenario: a provider prescribes a necessary medication, but when the patient tries to fill it at the pharmacy they are surprised to find out they can't afford it. When this happens, one-third of people walk away - leaving the medication they need at the pharmacy. Why do these surprises occur, what's the impact on patient outcomes, and is there a way to avoid medication cost surprises in the future? Arrive Health answers this question in the first of four posts we wrote for a blog series with The Health Management Academy. Check it out to learn Healthcare's Prescription for Consumer Choice and Affordability.

If you only plan to attend one healthcare cost trends webinar in Q4, make it this one. Insights, context, and commentary await.

Learn about the trajectory of healthcare spending in the U.S., the importance of PBMs in lowering drug prices, and more in this week's newsletter. https://lnkd.in/eqDyJs68

The cost 💲 of generic medications can fluctuate significantly 📉📈. At MedImpact Healthcare Systems, Inc. we've developed three innovative solutions to address high-cost generics. These solutions enable us to respond swiftly to price changes and optimize cost-saving opportunities for healthcare payers. #Healthcare Contact me to learn more! #wearemedimpact #atruepartner #utilizationmanagement #HCGs