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ERISA Industry Committee Sues Minnesota Over PBM Law

January 3rd 2025

The Employee Retirement Income Security Act (ERISA) Industry Committee filed a legal challenge against the Minnesota Department of Commerce, arguing that Minnesota’s Pharmacy Benefit Manager (PBM) Licensure and Regulation Act illegally interfered with employer-sponsored health plans by restricting plan design options and increasing costs.

AJMC
Prescription Rebate Guarantees: Employer Insights

July 19th 2024

To Expand Access to Cancer Expertise, Collaboration Is Key
To Expand Access to Cancer Expertise, Collaboration Is Key

February 20th 2023

stack of newspapers
What We’re Reading: Pediatric Vaccine Schedule Updated; Workplace Toll on Health; Drugmakers Lobby Against IRA Impact

October 21st 2022

Headlines overwhelming person.
Taking Action Against the Rising Mental Health Crisis: Efforts From Health Plans, Congress, and More

May 10th 2022

How Can Employers Safely Return Employees to the Workplace?

Recognizing trends in health care that align with the COVID-19 pandemic and related racial disparities can improve the design of timely and effective strategies by employers to safely return employees to the workplace.

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Denise Giambalvo, MBA, vice president, Midwest Business Group on Health.
May 27th 2021

Contributor: Companies Can’t Afford a She-cession

Denise Giambalvo, MBA Mim Senft
As working women have been disproportionately impacted by COVID-19, solutions to address what has been coined a “she-cession” include targeted communications, flexible work schedules, and increased education/tutoring resources.
Health cross.
May 21st 2021

WHO Study Finds Long Working Hours May Increase Risk of Stroke, Heart Disease Mortality

Matthew Gavidia
In 2016, long working hours were associated with 745,000 deaths and 23.3 million disability-adjusted life-years from ischemic heart disease and stroke combined.
Priya Rajendran, CEO of S'moresUp, director of Product Strategy at Ford Motor Company.
May 19th 2021

Addressing Job Turnover in Women, How to Accommodate Working Moms

Priya Rajendran, BS, founder and CEO of S’moresUp and director of Product Strategy and Connected Experiences at Ford Motor Company, discusses employers’ efforts to support working moms.
Suzanne Delbanco, executive director, Catalyst for Payment Reform.
May 13th 2021

Contributor: Do Health Plans Have a Plan to Help Employer-Purchasers Get Better Value?

Suzanne Delbanco, PhD, MPH
This article is co-written by Suzanne Delbanco, PhD, MPH, executive director, Andréa Caballero, MPA, program director, and Julianne McGarry, MPP, director of projects and research, for Catalyst for Payment Reform, and Robert S. Galvin, MD, chief executive officer, Equity Healthcare, LLC.
Bill Kramer, MBA, executive director for Health Policy, PBGH.
May 9th 2021

Exploring Employer Opinion on Government Intervention in Health Cost, Coverage

As the COVID-19 pandemic has laid bare issues of rising high health care costs and disproportionate coverage nationwide, executive decision makers at large employers indicated their support for greater government intervention to address concerns.
Stethoscope on money representing health care cost.
May 6th 2021

Survey Finds 1 in 6 US Workers Stay in Unwanted Jobs for Health Benefits

Matthew Gavidia
A survey by West Health and Gallup found that Black workers and those making less than $48,000 in the United States were more likely to stay in unwanted jobs out of fear of losing their health benefits.
Candice Sherman, CEO of the Northeast Business Group on Health.
May 2nd 2021

Employer Best Practices to Optimize Behavioral Health, Telehealth Coverage

Ensuring that employees have the assistance and tools necessary to meet telehealth and behavioral health demands is vital to promote safety and health amid the pandemic, along with lowering or eliminating out-of-pocket costs that can steer people away from cancer screenings, therapies, or aspects of high-value care.
COVID-19 headlines overwhelming an employee.
April 28th 2021

COVID-19–Related Lost Work Time Could Cost Employers Upwards of $50 Billion

Matthew Gavidia
An analysis by the Integrated Benefits Institute estimates that the total cost of lost time from work due to the COVID-19 pandemic could reach $50.5 billion, marking a 117% increase from prior projections.
Norman Chenven, MD, vice chairman of CAPP.
April 25th 2021

Spotlighting Physician, Purchaser Collaboration to Improve Care Delivery and Quality

Through direct roundtable discussions between health care purchasers and physician practices, efforts have been made to align care provided in the community with the wants and needs of employees and patients.
The Impact of Reinsurance of Gene Therapies on Employer Financial Risk
April 22nd 2021

The Impact of Reinsurance of Gene Therapies on Employer Financial Risk

Marc Hixson, MBA Neil B. Minkoff, MD Kim Gwiazdzinski, MBA, RPh Jim Clement, MHA
Christine Brophy, vice president of Behavior Change for Vitality.
April 18th 2021

Shaping COVID-19 Vaccine Education in the Workplace Through Communication, Prevention

In guiding employers on their education efforts regarding COVID-19 vaccines, a communication strategy characterized by fact checking, employee empowerment, and prevention is warranted.
Health care cost.
April 14th 2021

Addressing Physical, Emotional Pain in the Workplace Linked With Substantial Cost Savings

Matthew Gavidia
A report by the Harvard Business Review found a significant gap between employee needs and employer benefit offerings for treatment of physical and emotional pain, with a holistic approach associated with savings of 50% on medical claims for back and joint care.
April Todd, senior vice president, CORE and Explorations, CAQH.
April 12th 2021

Optimizing Interoperability of Administrative, Clinical Data to Accelerate Value-Based Payment Transition

Several barriers continue to impede the transition to value-based payment, particularly administrative and clinical data connectivity, transparency of quality metrics and quality measures, and prioritization of social determinants of health.
Health care workers reading on task.
April 9th 2021

Survey Finds Provider Burnout, Disengagement as Most Potentially Disruptive Trends in Health Care

Matthew Gavidia
A 2021 survey on health care trends to monitor finds provider burnout, disengagement, and shortage of health care professionals as the most potentially disruptive issues facing hospitals and health systems in the next 3 years.
Jeff Krauss, MD, chief medical officer at Hinge Health.
April 4th 2021

Analyzing Innovations in Musculoskeletal Care to Improve Patient Outcomes, Cost Savings

With musculoskeletal care representing one of the leading cost drivers in health care spending for self-insured employers and health plans, a transition to preventive care characterized by both digital and in-person care solutions can lead to improved patient outcomes and cost savings.
Synergetic energy between a group of individuals.
April 1st 2021

National Alliance Purchaser Survey Highlights Transition to Stabilized Business, Value-Based Care

Matthew Gavidia
A survey of employer and purchaser members of the National Alliance of Healthcare Purchaser Coalitions found that over half expect a transition to a more stabilized business environment by the third quarter of this year, as well as increased benefit offerings on mental health access and virtual care delivery.
Andrew Malley, chief executive officer of Dignity Health Global Education.
March 28th 2021

Workforce Development Implications for Health Care Systems During COVID-19 and Beyond

Investing further in the development of health care staff in often overlooked aspects, such as digital technology and business acumen, can lead to incremental differences in engagement and productivity.
Stethoscope on dollar bills.
March 26th 2021

Hinge Health: Musculoskeletal Costs Doubled in Past Decade With No Benefit in Patient Outcomes

Matthew Gavidia
Hinge Health’s State of MSK Report 2021 found that although patient outcomes remained stagnant in the past decade, cost for musculoskeletal care doubled with services provided in emergency rooms and outpatient/inpatient facilities associated with significantly increased spend.
Implications of Value-Based Care, Fee-for-Service Reimbursement Models Amid COVID-19
March 21st 2021

Implications of Value-Based Care, Fee-for-Service Reimbursement Models Amid COVID-19

Amid the pandemic, organizations utilizing a value-based care reimbursement model may be better positioned than those using a fee-for-service model to delineate high-risk patients and manage their care, particularly for long-term symptoms that may arise due to COVID-19.
Contributor: Improving Seniors’ Health and Outcomes With a Value-Based Care Team Approach
March 17th 2021

Contributor: Improving Seniors’ Health and Outcomes With a Value-Based Care Team Approach

Patricia Hayes, MD
A value-based care team approach can be utilized to adequately treat patients’ medical problems, particularly by addressing the social, economic, and environmental challenges they’re facing in their everyday lives.
Virtual Care Adoption: Barriers to Access, Engagement Strategies, and Opportunities for Growth
March 14th 2021

Virtual Care Adoption: Barriers to Access, Engagement Strategies, and Opportunities for Growth

With a marked increase in virtual care use amid the COVID-19 pandemic, several strategies can continue to evolve its effectiveness and adoption. This includes addressing disparities in usage among older populations and underserved communities, as well as improving home monitoring and interoperability.
How New Price Transparency Requirement Will Impact Care Delivery for Health Systems, Patients
March 11th 2021

How New Price Transparency Requirement Will Impact Care Delivery for Health Systems, Patients

To adapt to a new requirement this year for all US hospitals to publicly post the costs for treatment services under every insurance plan, health systems should be prepared to field the range of questions that consumers may ask on issues such as outcomes data and cost for prospective services.
CVS Health’s 2021 Health Trends Report Spotlights Virtual Care, EHR Optimization
March 9th 2021

CVS Health’s 2021 Health Trends Report Spotlights Virtual Care, EHR Optimization

Matthew Gavidia
Citing 2021 as the year of the pharmacist, this year's CVS Health’s Health Trends Report discusses pressing issues for pharmacists to monitor, including availability of COVID-19 vaccines to communities nationwide, as well as integration of telehealth and behavioral health services.
Contributor: How Balancing Compliance, Comprehension, and Privacy Can Optimize Access to Patient Data
March 6th 2021

Contributor: How Balancing Compliance, Comprehension, and Privacy Can Optimize Access to Patient Data

Karen Kobelski, MBA
In preparing for the upcoming implementation of the Interoperability and Patient Access final rule by CMS, best practices for health plans include prioritizing data mapping, sensitivity codes for privacy, and consumer-friendly language in accessible data for patients.
Jeffrey Hogan (left) and AJMC's Matthew Gavidia (right)
February 28th 2021

Jeffrey Hogan Discusses Helping Health Care Payers Create Pandemic Infrastructure

Jeffrey Hogan, Northeast regional manager of the Rogers Benefit Group and member of the Board of Directors for the Connecticut Business Group on Health, discussed how his organization helped providers navigate some of the challenges posed by the pandemic.
Financial, Emotional Costs of Taking a Sick Day Rising Amid the Pandemic
February 25th 2021

Financial, Emotional Costs of Taking a Sick Day Rising Amid the Pandemic

Matthew Gavidia
A survey found that 42% of US working adults were more stressed or anxious in the past year about taking a sick day to care for themselves or someone else compared with years past, with 1 sick day currently associated with a $227 earnings loss.
Denise Giambalvo on Upcoming Discussions at MBGH’s Behavioral Health Program
February 21st 2021

Denise Giambalvo on Upcoming Discussions at MBGH’s Behavioral Health Program

The Midwest Business Group on Health's program this week on behavioral health will explore strategies that employers have implemented to address rising anxiety and financial stressors in the workforce amid the coronavirus disease 2019 pandemic.
Supporting COVID-19 Vaccination Efforts: Advice for Employers
February 18th 2021

Supporting COVID-19 Vaccination Efforts: Advice for Employers

Matthew Gavidia
An article by Willis Towers Watson discusses how employers are supporting their respective workforce amid the pandemic, with education of approved vaccines and effective communication channels with state and local health departments referenced as key actions to be taken at this time.
Assessing Health Care Policy Reform at the Federal and State Levels
February 14th 2021

Assessing Health Care Policy Reform at the Federal and State Levels

In addition to coronavirus disease 2019, several other factors will play a major role in health care policy reform for federal and state-level health officials this year, including the transition to value-based care and containment of high health care costs.
Artificial intelligence
February 11th 2021

Humana, IBM Watson Health Collaborate to Improve Health Benefit Transparency

Matthew Gavidia
Humana and IBM Watson Health collaboration to streamline access to accurate information on benefits and health care costs for Humana employer group members, agents, and employers.
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