Insurance

Commercial and Medicare Advantage Payment for Anesthesiology Services

June 16th 2021, 1:00pm

Article

Mean in-network commercial allowed amounts and charges per anesthesia conversion factor are 314% and 659% of traditional Medicare rates, respectively. Medicare Advantage payments align with traditional Medicare prices.

Pandemic Factors Driving Predictions for 2022 Medical Cost Trends

June 15th 2021, 10:00pm

Podcast

On this episode of Managed Care Cast, we speak with the author of the annual PwC Behind the Numbers report, which looks ahead at medical cost trends in the United States.

Association of Co-pay Elimination With Medication Adherence and Total Cost

June 15th 2021, 1:00pm

Article

This study evaluated cost and utilization attributed to members enrolled in a health care program with no pharmacy co-pay. Health care savings were identified in addition to medication adherence improvements.

Association Between Hospital-Insurer Contract Structure and Hospital Performance

June 14th 2021, 1:00pm

Article

Hospital performance measures, such as prices and costs, are associated with hospital-insurer contract types.

Adoption of the Lower Drug Costs Now Act May Lead to Billions in Savings

June 11th 2021, 5:00pm

Article

A new study from Milliman investigated the potential financial impact if H.R.3, the Elijah E. Cummings Lower Drug Costs Now Act, was fully implemented.

What We’re Reading: Donating 500 Million Pfizer Doses; Resignation Over Alzheimer Drug; Nevada’s Public Option

June 10th 2021, 2:05pm

Article

United States to buy and donate 500 million COVID-19 vaccine doses to the world; an FDA advisor resigns over a controversial Alzheimer drug approval; Nevada becomes the second state to offer state-managed health insurance plans.

Who’s Driving the Growth of Medicare Advantage Plans?

June 9th 2021, 10:30am

Podcast

In this episode of Managed Care Cast, we speak with a coauthor of an article in June’s Health Affairs examining the racial and ethnic composition of beneficiaries in Medicare Advantage plans and the potential implications as the program continues to grow.

US Health Plans Addressing Rising Drug Costs With Step Therapy, Value Assessment Frameworks

May 19th 2021, 10:00pm

Article

As the cost of therapies increases, US health plans are utilizing tools like step therapy, to ensure patients try cheaper alternatives first, and value assessment frameworks, to assist with the decision-making process.

Understanding Cost Considerations Around Diabetes Technology in the T1D Community

May 19th 2021, 1:30pm

Article

Results of a qualitative study outline widely held cost considerations regarding diabetes technology in the type 1 diabetes (T1D) community.

Digital Sleep Therapeutic Would Save Costs for Payers, Employers, Analyses Find

May 14th 2021, 3:33pm

Article

When patients had the option of using prescription digital therapeutics, their insurers and employers saved significant money in both direct and indirect medical costs, the 2 studies found.