Eric Miller, FSA, CERA, MAAA’s Post

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

PBMs are Undermining Patient Care and Independent Practices but this is an avoidable problem if you draw on proven methodologies. A gastroenterologist shares firsthand experiences of how Pharmacy Benefit Managers (PBMs) and insurance companies are creating unnecessary barriers to patient care. Key issues: • Forced switches to "preferred" biosimilars (a fancy name for a generic) • Delays due to prior authorizations • Financial strain on medical practices The consequences? Delayed treatments, potential disease recurrence, and added stress for patients already dealing with chronic conditions. Want to learn how to avoid these issues? Join us at RosettaFest.org or sign up for a virtual all-access ticket to: ✅ Learn from Health Rosetta Advisors and employers who have successfully navigated these challenges for their clients ✅ Access the procurement, contracting, and data use "field guide" - a valuable resource aggregating the collective wisdom of the Health Rosetta community. This is a free/open source resource and we’ll be expanding the experts who will advance these resources making them even more valuable. It's time for greater transparency and a reevaluation of these troubling policies. Patients deserve better, and solutions are within reach. #HealthcareReform #PatientCare #PBM #MedicalPractices #RosettaFest --- Read more about how PBMs are stacking the deck against patients and independent physician practices in this eye-opening article: https://lnkd.in/gh6UTb6T

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

As PBMs grow more complex, many organizations are asking critical questions. Here are 8 strategies organizations can explore to determine what is right for their business.

Agadia Systems specializes in healthcare technology, focusing on solutions that streamline and automate prior authorization (PA) processes for payers, pharmacies, and providers. Their platforms aim to reduce administrative burdens and enhance compliance with evolving regulations. Agadia's products are designed to integrate with electronic health records (EHRs) and other healthcare IT systems, ensuring a seamless and efficient workflow. Key Features of Agadia's PA Solutions: 1. ePA Automation: Facilitates electronic prior authorization (ePA) to minimize manual paperwork and speed up the approval process. 2. Compliance Management: Helps organizations comply with regulations from entities like the Centers for Medicare & Medicaid Services (CMS). 3. Integration Capabilities: Works with pharmacy management and EHR systems to enable end-to-end PA management. 4. Custom Solutions: Offers tailored software solutions based on client needs, including payer-focused and provider-focused tools. Would you like details about a specific product, their implementation process, or insights into how their systems can help your organization?

💉2010-2024: Medicare Dropped Prices on 251 Drugs 💰Like Eloxatin, Some Dropped by 99% 👇Did Hospitals Drop their Prices to Pass along these Savings? 💥Medicare's price drop often means lower acquisition costs. 👉Instead, many Health Plans allowed higher prices, driving larger margins for Hospitals at the expense of Patients and Employers. This pattern is seen in hospitals nationwide. We're partnering with clients to challenge these practices. Medicare data shows a price drop on 251 drugs (2010-2024). Did your health plan and hospitals drop their prices? To uncover these hidden practices, you need to deeply analyze your transparency and claims data and marry it up with acquisition cost data. Find these key insights and hold hospitals and health plans accountable. Contact us to start your analysis today.

🚨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

The Congressional Budget Office weighs in on health policy priorities from pharmacy benefit management and Medicare spending to modeling the cost of care with AI. Read the biggest takeaways: https://hubs.la/Q02t40-00 #HealthPolicy #healthcare #pharma

Prescription digital therapeutics (PDTs) are one of the major digital healthcare innovations of all time. They bridge accessibility issues, ongoing care challenges and several other gaps in the healthcare industry. They provide care beyond traditional settings. The global PDTs market is estimated to reach USD 32.5 billion by 2030, up from USD 6.2 billion in 2023, growing at a CAGR of 27.2%. The recent finalisation of 2025 Centers for Medicare & Medicaid Services billing codes for behavioural health PDTs has created a good buzz in the PDTs sector. What is this buzz around PDTs? Will it live up to the hype? Read on to know what’s happening in the PDTs sector, understand their use cases and future expansion potential 👉 https://lnkd.in/g3u2YT4P Follow All Health Tech for more such insights. #AllHealthTech #DigitalTherapeutics #PDTs #DigitalHealthcare #Healthtech