MediFormatica’s Post

The Washington State Office of the Insurance Commissioner recently released it's findings on improving #accesstocare: 1. Creating a reinsurance program in the individual and small group health insurance markets. 2. Increasing the minimum medical loss ratio standard for all commercial health plans to 88%. 3. Using reference-based pricing for health care facility and provider payments where the price for health care services is tied to Medicare reimbursement rates. 4. Using hospital global budgeting to pay hospitals a fixed amount for all inpatient and outpatient services provided to a patient population in a given year.  5. Meeting the Health Care Cost Transparency Board’s expenditure growth targets. https://lnkd.in/gDEzzGUr

For years, Bupa has worked towards offering our customers a health journey that brings us closer to them with personalised healthcare services, and a few weeks ago I posted a bit about how exciting it is that it's becoming a reality through Bupa's Connected Care ambitions. One of the foundations of making this a reality is breaking down the walls between our different services, creating a unified view of your health journey, while still maintaining secure confidentiality. This means that whether you're visiting a Bupa dental clinic, making an insurance claim, or seeking advice through our digital channels, we're able to offer you consistent, personalised care. We've also developed systems that allow us to communicate with our customers in the way they prefer, all with the idea of building deeper, more meaningful relationships. #healthcare #artificialintelligence #insurance

OPD Coverage in Health Insurance: A Growing Trend Did you know? OPD coverage has surged from 0.80% in 2019 to 15.20% in 2023! What are OPD Expenses? OPD (Outpatient Department) expenses refer to costs of treatments and diagnoses without hospitalization, accounting for over 70% of healthcare costs. Benefits of Adding OPD Coverage: 1.⁠ ⁠Comprehensive Coverage: Covers doctor consultations, diagnostic tests, and medicines. 2.⁠ ⁠Multiple Claims: Claim OPD expenses multiple times during the policy period. 3.⁠ ⁠Ideal for Everyone: Suitable for senior citizens, individuals prone to minor illnesses, and those with frequent consultations. Why Choose OPD Coverage? •⁠ ⁠Reduces out-of-pocket expenses •⁠ ⁠Enhances financial protection •⁠ ⁠Provides peace of mind •⁠ ⁠Flexible and valuable addition to your health plan For expert guidance on selecting the best OPD policy ( which includes consultancy, medicine, and lab test) with instant coverage, cashless benefits, and hassle-free claims Contact us.. Regards Prankul Jain 9999097569 Stay updated, stay ahead! #Healthinsurance #OPDcoverage #healthcare #Insuranceclaims #Insurance #healthandwellness

The latest Fierce Healthcare article showing the J.D. Power U.S. Health Insurance Study underscores a significant opportunity for innovation! Payers must continue to advance their digital offerings, focusing on creating intuitive, efficient and easy-to-use tools that seamlessly integrate into members' lives. Enhancing the digital experience can significantly boost member satisfaction and retention, while also reinforcing the compelling case for continued investment in digital infrastructure. We have all come to expect seamless digital experiences in every aspect of our lives, and I believe that the payer industry is poised to rise to these high standards moving forward. #DigitalHealth #HealthcareInnovation #PatientExperience #HealthTech

We've been deep-diving into 8 reasons why we believe ICHRA is a game-changer for employees. Let's continue our journey with reason #6: ICHRAs give employees more benefits than other HRAs. ICHRA stands out among various HRAs available to companies and employees, offering unparalleled flexibility. As organizations seek alternatives to traditional group health insurance plans, HRAs are gaining traction for their adaptability. Over the years, HRAs have evolved, branching into various reimbursement options. While QSEHRA has shown success, it does come with limitations, unlike EBHRAs which cover specific benefits such as copays and deductibles. In contrast, ICHRA offers enhanced flexibility for both small and large businesses. Moreover, employees can receive reimbursements for insurance premiums, making it a compelling choice. We firmly believe that ICHRA represents an advancement in HRAs, offering a wider array of options to employees, regardless of company size or location. This versatility is driving its increasing popularity among health group plans. Curious if ICHRA could benefit your team? Reach out to us! We'd love to chat. venteur.com

There's talk that CVS Health may unload its insurance business...Aetna. Aetna continues to underperform. Are you and your employees paying the price? 💰 There are Better Paths Forward and they start with The Hilb Group. #CFO #HR #employeeengagement #employeebenefits #costtransparency

"Too big to fail." That feels unsettling, because it might be happening. Rapid consolidation was supposed to yield better quality, more choices, greater access. But it hasn't. In fact, quality is still challenged, and guess what else has happened ... costs have risen. Why? Less competition combined with dominant companies that are in business to make a profit ... resulting in constant pressures to grow profits. And guess who's impacted the most? Individuals and businesses that are shouldering the costs of healthcare through their health insurance premiums. https://zurl.co/ZkME If you're continuing to simply renew with the same large carrier every year, it's not going to get any better. Stop accepting the "status quo", and contact Mitigate Partners to learn how we can help you get Healthcare that Works. Contact an advisor near you. https://zurl.co/lP8p #healthcarecosts #pricetransparency #ceo #cfo #cfoforum #employeebenefits #healthcareplans

Anyone with insurance has a horror story like this. (I’m guessing) It’s easy to conclude that payers are not in the business of paying for their members healthcare costs. No, it seems more about covering as little as possible, and then refusing to pay for as much of what is covered as they can get away with. A nefarious plot to squeeze money out of everyone who pays premiums. (Not to mention those who provide healthcare) I think that gives health insurers too much credit. Hanlon’s Razor reminds us to question competence before questioning intentions. Having worked with many folks at insurance plans over the years, I don’t believe they are malicious. I do believe that the perverse set of incentives on all side of the question is what drives the behavior we see. It would be irrational not to act in accordance with incentives. Maybe I’m wrong - is it malice? Or is it competence? What do you think? #healthcare #innovation #payers https://lnkd.in/gQt_Fgnq

Until companies take control of their "healthcare" by demanding outcome base healthcare instead of the fee for service "sickcare" system we currently have, nothing will change. Leading companies are doing it and getting better care at lower cost.

According to a new J.D. Power report, about 32% of health insurance sites and apps “don’t meet the foundational level of functionality and intuitive organization of information.” To learn more about assuring digital experiences for patients and healthcare providers, check out ThousandEyes' latest eBook: https://lnkd.in/eXcq5bZ3 #healthinsurance #healthcare #digitalexperience