Paul Young’s Post

Public Health at a Crossroads: Examining the Potential Impact of a National Public Health Plan in the US The U.S. is debating a national public health plan, with over 40% of Americans already covered by Medicare and Medicaid. Expanding to a government-run health insurance option could reshape healthcare, but concerns include financial strain on hospitals, reduced provider participation, and the potential elimination of private insurance, leading to a single-payer system. Key challenges include maintaining provider financial sustainability, ensuring access to care, and addressing regulatory and operational issues. Policymakers must balance public and private interests to achieve a robust, accessible healthcare system. For more details please click the link! https://lnkd.in/djjjBrv3 #marketaccess #reimbursement #pricing #hta #heor #healtheconomics #medicaldevices #pharmaceutical 

High out-of-pocket healthcare costs and complex insurance structures severely impact patient access to care and their overall healthcare experience, according to an Ipsos survey with PhRMA. Among nearly 2,600 adults, many report that increasing costs prevent them from accessing necessary treatments, especially prescription medications. Additionally, the convoluted insurance process—marked by denials and benefit complexities—creates barriers for patients, with 41% reporting insurance-related access delays, a figure that rises to 51% among those with chronic illnesses. This uncertainty around costs affects patient engagement, as 43% fear future coverage denials. Furthermore, over half struggle to predict their prescription costs or understand insurance benefits, leading to dissatisfaction with insurance companies and calls for accountability. Beyond affordability, patients prioritize safe, preventive, and personalized care, with 91% valuing innovative treatments. As healthcare policy looms in upcoming elections, 94% of patients urge policymakers to address these financial barriers to ensure better healthcare accessibility and engagement. Our RCM team helps mitigate patients' financial barriers by optimizing insurance processes, ensuring accurate billing, and minimizing out-of-pocket costs through streamlined claim management. By enhancing plan navigability and reducing denials, we empower healthcare entities to improve patient access to care and foster adherence to prescribed treatments. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner TechTarget

Some interesting stats on how healthcare is changing

Rose McNulty, writing for AJMC - The American Journal of Managed Care, reports on the release of a playbook by the America's Health Insurance Plans (AHIP), the American Medical Association (AMA), and National Association of ACOs (NAACOS), which outlines voluntary best practices for value-based care (VBC) payment arrangements. This playbook is part of a joint effort to boost the adoption of value based care (VBC) in the private sector and enhance the quality, fairness, and affordability of healthcare. The playbook aims to simplify, coordinate, and expand VBC arrangements, building upon prior efforts to promote data sharing in VBC. Drawing from experiences in implementing VBC, the playbook seeks to raise awareness of effective strategies and reduce obstacles hindering participation, such as administrative burdens. The initiative, spearheaded by AHIP, AMA, and NAACOS through the Future of Value Initiative, reflects the significant growth of value-based care over the last decade, with accountable care organizations alone constituting 20% of Medicare. To develop the playbook, an advisory workgroup of AHIP, AMA, and NAACOS members conducted a comprehensive process, including literature review, environmental analysis, and expert interviews. Emphasizing diversity in VBC experiences and practice characteristics, the group also addressed the specific needs of rural and underserved communities. The playbook encompasses seven key domains, offering recommendations, insights, and practical examples to facilitate the implementation of sustainable VBC payment arrangements, ultimately aiming to enhance healthcare outcomes and reduce costs. #ValueBasedCare #Healthcare #PaymentArrangements

Group health plans and health insurance issuers must annually submit detailed information on prescription drug and health care spending to the Centers for Medicare & Medicaid Services (CMS). This reporting is referred to as the “prescription drug data collection” (or “RxDC report”). The next RxDC report is due by Saturday, June 1, 2024, covering data for 2023. The RxDC report is composed of several files, including those that require specific plan-level information, such as plan year beginning and end dates and enrollment and premium data. It also includes files that require detailed information about medical and pharmacy benefits. Most employers contract with third parties, such as issuers, third-party administrators (TPAs) and pharmacy benefit managers (PBMs), to submit RxDC reports on behalf of their health plans. Employers may work with multiple third parties to complete the RxDC report for their health plans. For example, a self-insured employer may use both its TPA and PBM to submit different portions of the RxDC report. A health plan’s submission is considered complete if CMS receives all required files, regardless of who submits them. For more details: https://lnkd.in/gxjJbXE8

Healthcare providers are facing a critical issue with major insurance companies' rise in denied care. A recent Senate Report has shed light on unethical practices, such as automatic denials and obstructing providers from obtaining authorization or reversing denials for necessary care. Physicians, medical societies, and patients should contact their congressional representatives and demand immediate intervention against these practices. While many government leaders acknowledge the problem, they have been unable to restrict or stop the process and have failed to offer hope that a clear solution is on the horizon. Is there an alternative approach from the private sector to ensure accountability and transparency for Insurance Companies and their denial/approval system administrators like EviCor?

Health insurance plans are seeing continued growth in the adoption of value-based care arrangements and shared risk arrangements, according to the 2024 annual survey by the Health Care Payment Learning & Action Network (HCPLAN). The HCPLAN is a group of public and private healthcare leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate the adoption of alternative payment models (APMs) and accountable care. Every year, the HCPLAN conducts a national effort to assess the adoption of APMs over time and track progress towards the HCPLAN’s goals. Since its start in 2015, the Measurement Effort has evolved to incorporate data from a large sample of payers that represents nearly 92% of covered Americans, and now serves as the most comprehensive snapshot available for measuring progress on payment reform. In 2018, the HCPLAN began reporting payment data by line of business (LOB) — Commercial, Medicaid, Medicare Advantage, and Traditional Medicare. https://lnkd.in/gmZhamc5

💢 The Growing Concern of Out-of-Pocket Healthcare Costs Out-of-pocket healthcare costs are becoming a major barrier to patient satisfaction and access to quality care. High deductibles and surprise bills are forcing many to delay or even skip treatment, making patients lose trust in our healthcare system. According to an Ipsos poll, 3 in 4 insured Americans do not believe that health insurance provides everyone with affordable access to necessary care. Many individuals support policies that reduce the amount of out-of-pocket costs that patients have to make, like annual payment caps. Providers can do their part in improving the patient experience by adopting transparent billing, financial tools, and clear communication about patient finances. However, real progress in care affordability demands systemic changes to improve accessibility across the board. ⚙️ Need help managing your private physician practice? Priority Practice Management takes the burden of administrative duties off your heavy workload so you can keep the focus on your patients. Learn more ➡️ https://lnkd.in/gpYmTyzz #PrivatePractice #Physicians #HealthAdministration #PrivateDoctor 📚 Full article: https://lnkd.in/ehNJ7xE6

Did you know that there are LIFETIME penalties for late enrollment in Medicare Part D? 🚫💲 What does this have to do with employer-sponsored health insurance benefits? 🙃 Employers offering health insurance with prescription drug coverage, along with their brokers, share the responsibility of educating Medicare-eligible employees. There is a reporting responsibility for the employer, and in my opinion, a moral responsibility for the broker. Failing to do so may lead to employees missing timely enrollment in Medicare Part D, resulting in LIFETIME monthly penalties that are added to their premiums. These employers must provide a disclosure to Medicare eligible individuals and dependents before Oct 15th, 2024. This disclosure informs them whether or not the prescription drug coverage offered by the employer’s plan is “creditable” or “non-credible.” Creditable coverage means the plan is expected to pay, on average, as much as standard Medicare Part D coverage. Most fully insured employer sponsored plans are credible but there can be a handful that are not and that amount may be increasing with changes that are coming. It is becoming increasingly important to distribute these notices and educate employees due to several factors that may be impactful: 1️⃣ More individuals becoming Medicare-Eligible: 👉Think about the ongoing aging of the Baby Boomer generation. 2️⃣ IRA Provisions: 👉Inflation Reduction Act of 2022 introduced several changes aimed at reducing drug costs for Medicare beneficiaries, which began rolling out in 2023 and 2024. 3️⃣ Greater Regulatory Scrutiny: 👉 There seems to be a greater a focus on compliance that could potentially increase in coming years. 4️⃣ Post-COVID Shift in Healthcare Utilization: 👉 This trend includes an increase in individuals using prescription drug services. As a practical matter, group health plan sponsors often provide the creditable coverage disclosure notices to ALL plan participants. #compliance #impactful #reporting #medicare #lifetimepenalities Morrison Insurance Services, Inc.

Great to see Independent Healthcare Providers Network (IHPN)'s “Going Private 2024” report covered in the Times today. https://lnkd.in/eHwhppVd The report - supported by Bevan Brittan LLP, looks at public attitudes to private healthcare – what people think about it, what services do they use, what do they understand about it. Overall the research, found that a majority of the public would consider using private healthcare, as paying for treatment becomes the “new normal” ➡ Almost seven in ten of people (67%) say that they would consider using private healthcare, with over one third (34%) saying they would pay for treatment in the next 12 months if they needed it. This rises to almost half (44%) of 25-34-year-olds who expect to use private healthcare in the coming year. ➡ Almost one third (32%) of people surveyed stated they had previously used private healthcare. Unsurprisingly given that NHS waiting lists are at record levels, speedier access to care is the top reason for people choosing to use private healthcare, with over half (54%) of all 18 to 24-year-olds who have used private healthcare previously having done so to access a private GP appointments. ➡ Of the general public that have used private healthcare previously, over two in five (42%) went straight to pay for care rather than trying the NHS first. ➡ There’s been a significant rise in the proportion of people using private medical insurance (PMI). Of those that have used private healthcare, six in ten (58%) said they paid through PMI compared with under half (49%) in 2023. Perhaps unsurprisingly, 55% of respondents indicated that they would be somewhat or much more likely to apply for a job if it came with PMI. ➡ Regardless of whether they used insurance or self-pay, the vast majority (88%) of people who have used private healthcare considered it worth the expense. The full results can be found here: https://lnkd.in/eibiBRPa