On February 10, 2022 price inflation jumped by 7.5% over the past 12 months, its highest annual increase in 40 years. For employers and other health care purchasers that monitor their claims cost and utilization data religiously (who doesn’t?), this news prompts questions from purchasers about how inflation will impact their future health care spend.
Getting these details right will determine if implementation of the No Surprises Act will not only protect patients from most high and unexpected medical costs but also help reduce the need for balance billing in the first place and keep prices in check.
Suzanne Delbanco speaks with Jason Richmond, Head of Consultant Relations at Ginger, a digital mental health care provider. Jason Richmond explores the supply and demand imbalance between mental health patients
Back in October 2019, we published a blog post on the challenges of building a high-performance network (HPN). We landed on the conclusion that an HPN should be designed with sensitivity to
“What’s great about [direct contracting] relationships is they allow for an employer to work directly with a health system in developing a solution that’s specific to their employee base. They can design programs that address their specific needs, such as addressing diabetes issues within their employee population or behavioral health. In return, the health system expects employers to develop benefit plans and contribution strategies that steer their employees to that health system.”
“Are there opportunities to steer to a quality provider or facility down the street? If we can’t do that with the data, then we’re not serving the interest of our employers and their employees and getting them the health care that they need.” – Thi Montavlo, Willis Towers Watson
Suzanne Delbanco catches up with CJ Stimson, MD, JD, the Senior Vice President of Value Transformation at Vanderbilt University Medical Center (VUMC), to discuss Vanderbilt’s direct contract bundled payment arrangement for maternity care with Metro Nashville Public Schools (MNPS).
Employers and consumers are eager for solutions that attack health care cost inflation at its root cause. One prominent strategy is using reference-based pricing (RBP) models that anchor commercial rates to Medicare, or some other rationalized external benchmark. Like so many health care innovations, reference-based frameworks encompass multiple branching models, and as such the term “RBP” has come to mean different things to different stakeholders.
Andréa Caballero, MPA, speaks with Linda Schwimmer, JD, President and CEO of the New Jersey Health Care Quality Institute (Quality Institute) to learn about a pressing issue: the health of New Jersey’s Small Group Insurance Market.
Would 2020 be the year that health care purchasers finally abandon broad PPO networks in favor of curated solutions like narrow, tiered or high-performance networks? Julianne McGarry review’s KFF’s 2020 Employer Health Benefits Survey to find out.
Suzanne Delbanco connects with Chris Cigarran, CEO of Imagine Health, an alternative health plan offering curated provider networks in select markets across the country. Prior to Imagine Health, Chris built the employer and government sales division of a wellness company and has also served as Chief HR Officer.
Suzanne Delbanco interviews Ashok Subramanian, CEO and Founder of Centivo Health, an alternative Third-Party Administrator (TPA) that emphasizes value-based direct contracting and utilization of high-quality providers.
Health equity provides the principles and framework to address the maternal health disparity crisis in the U.S. The premise is simple: By improving care for those most likely to face poor outcomes, stakeholders can ensure that the health system is preventing poor outcomes for all patients.
Tune in to hear from Mediquire’s CEO, Emily Chen, on using data in direct contracting arrangements between employers (and other health care purchasers) and providers
How and why are social determinants of health programs making their way into the Medicaid managed care realm? To find out, Suzanne Delbanco calls Tricia McGinnis, MPP, MPH, Executive Vice
Unpacking the complexity of high-performance network design The National Business Group on Health (NBGH) predicted that by 2018 a staggering 61% of employers would offer narrow or high-performance networks (HPNs).
Last week, we told you about a $4,999 surprise bill. I didn’t have a $4,999 surprise, but it was close. At 30 years old, I had a tonsillectomy. I was
What happens when a patient goes to the emergency room and gets treated by a doctor that’s out of network – even if the hospital facility is in-network? Or if
Suzanne Delbanco chats with Frank Opelka, MD, FACS, Medical Director for Quality and Health Policy with the American College of Surgeons, to understand how surgeons across the United States view
Listen in as CPR’s Executive Director, Suzanne Delbanco, chats with Google’s Former Healthcare Delivery Benefits Manager, Rob Paczkowski. Just like the HR department of many employers, the benefits team at
