Articles on this Page
- 09/20/18--06:15: _Apple Watch or simi...
- 09/20/18--10:52: _Employers, insurers...
- 09/20/18--11:03: _LISI Partners with ...
- 09/21/18--16:54: _beWellnm will launc...
- 09/26/18--00:24: _Will 'Modicare' be ...
- 09/23/18--08:02: _Ninestone Selected ...
- 09/25/18--09:15: _Fin24.com | India l...
- 09/25/18--04:01: _Garland Road Nursin...
- 09/25/18--07:28: _Gemphire Therapeuti...
- 09/25/18--08:04: _Bernard Health Anno...
- 09/25/18--13:48: _Amerigroup Again Ra...
- 09/25/18--13:48: _UniCare Ranked Amon...
- 09/26/18--00:28: _NCQA Releases 2018 ...
- 09/25/18--22:26: _Robert Reich: Donal...
- 09/25/18--23:04: _PMJAY scheme has im...
- 09/26/18--00:38: _Avrist Supports HR ...
- 09/26/18--03:04: _Loyale Healthcare, ...
- 09/26/18--06:01: _Oak Street Health a...
- 09/26/18--07:14: _Best’s Special Repo...
- 09/26/18--10:04: _Survey: Small Busin...
- 09/20/18--10:52: Employers, insurers prepare for 2019 health insurance season
- 09/20/18--11:03: LISI Partners with BenRevo to Streamline Large Group Quoting
- 09/21/18--16:54: beWellnm will launch its own exchange platform
- 09/26/18--00:24: Will 'Modicare' be a success in India?
- 09/23/18--08:02: Ninestone Selected to be MA DSRIP TA Marketplace Approved Vendor
- 09/25/18--09:15: Fin24.com | India launches 'Modicare', world's biggest health scheme
- 09/25/18--13:48: UniCare Ranked Among Top Medicaid Plans in West Virginia by NCQA
- 09/26/18--00:28: NCQA Releases 2018 Health Insurance Plan Ratings
- 09/25/18--22:26: Robert Reich: Donald Trump Has Betrayed The Working Class – OpEd
Venerable health insurance company John Hancock is pivoting towards "interactive life insurance," with the provider now requiring all policy holders to track their fitness with wearables and apps.
Reported by AppleInsider 6 days ago.
With enrollment for 2019 health insurance just weeks away, businesses are trying to calculate what they’ll pay in the new year. That follows a summer of changes, lawsuits and new regulations from the state and federal government.
Reported by bizjournals 6 days ago.
LISI partners with BenRevo to simplify the entire large group process from RFP through presentation
LOS ANGELES (PRWEB) September 20, 2018
LISI Inc., a prominent general agency, has partnered with BenRevo to simplify the entire large group process from RFP through presentation. BenRevo connects carriers, brokers, and customers on a common platform, slashing the time and work it takes to get a quote.
With advanced quoting and analysis, BenRevo’s online platform streamlines the RFP process and ensures that brokers get the most accurate and competitive quotes. Brokers can effortlessly fill out RFPs and get every proposal in one place. Advanced analysis tools make it easy to compare quotes from multiple carriers.
The BenRevo team consists of experienced insurance and technology professionals who are dedicated to improving the way benefit policies are quoted, purchased, and implemented. “BenRevo” and the BenRevo Logo are registered trademarks or service marks of BenRevo, Inc.
As California’s premier general agency, LISI serves more than 8,000 affiliated brokers who offer Medical, Dental, Vision and Specialty coverage for large and small employers from over two dozen carriers. LISI offers a highly responsive, regional approach with offices throughout California. LISI’s statewide scale leverages their strength in working with carriers on brokers’ behalf. LISI Inc. has served health insurance brokers since 1977. For more information, please visit LISI. Reported by PRWeb 6 days ago.
BeWellnm's board of directors voted unanimously Friday for the New Mexico Health Insurance Exchange to become a state-based exchange, which the organization said will streamline operations and save clients money. Cheryl Gardner, the insurance exchange's CEO, said beWellnm is currently operating with a federal technology platform, which had a price tag of $5.5 million as of this year, with estimates of reaching $10.9 million by 2019 and $14 million by 2020. The organization will look at vendors…
Reported by bizjournals 5 days ago.
India has launched its new flagship health insurance scheme, dubbed "Modicare".
Reported by BBC News 9 hours ago.
Ninestone Corporation today announced that they are an approved vendor in the MA DSRIP TA Marketplace. Ninestone consultants are prepared with operational experience, systems expertise, and creative problem-solving skills to assist ACOs and CPs with design and implementation of new or improved programs/processes to enhance their ability to provide integrated, high quality health outcomes and an improved member experience.
LEXINGTON, Mass. (PRWEB) September 23, 2018
Ninestone Corporation, a management consulting firm that specializes in working with healthcare, small business and non-profit organizations, announced today their selection as an approved vendor to participate in the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Technical Assistance (TA) Program and the TA Marketplace in the Health Information Technology/Health Information Exchange and Care Coordination-Integration TA Domains.
Ninestone empowers healthcare organizations to achieve operational and financial success by maximizing the value gained from business and technology investments. By leveraging our people, processes and available technology, Ninestone is able to identify and implement realistic solutions that address healthcare’s unique challenges.
“We are excited at the opportunity to be an approved TA Vendor and are looking forward to engaging with Community Partners (CP) and Accountable Care Organizations (ACO) to assist them in enhancing their ability to provide integrated, high quality care to MassHealth members,” noted Jennifer Venditti, President of Ninestone.
Ninestone understands the challenges that contracted organizations experienced while preparing to meet the ACO and CP program launch requirements. With the programs now underway, Ninestone is looking forward to helping organizations recognize opportunities for improvement that result in better health outcomes, an improved member experience, and the agility needed to overcome barriers to success.
About MA TA Marketplace
The MA DSRIP Technical Assistance Marketplace (TA Marketplace) is part of a broader initiative of MassHealth, the Commonwealth of Massachusetts’ Medicaid and Children’s Health Insurance Program, and contractor Abt Associates Inc. (Abt) which aims to support ACOs and CPs in improving health outcomes and experience for Medicaid patients throughout Massachusetts. The TA Marketplace serves to enable MassHealth ACOs and CPs to easily navigate and tap into the array of resources and supports available to them through the MassHealth DSRIP TA Program. It is through the TA Marketplace that ACOs and CPs can learn more about the TA Vendors available to them through this program.
Ninestone Corporation is a woman owned, MA WBE certified consulting firm that combines its broad systems expertise, deep operational experience, creative problem solving acumen, and rigorous management process to deliver highly successful projects on time and on budget. Whether designing and implementing new programs/processes or revising existing ones to improve efficiency, we partner with our clients from assessment through planning and execution.
For more information, please visit the Ninestone website: http://www.ninestone.com.
781-652-8204 Reported by PRWeb 3 days ago.
Prime Minister Narendra Modi has launched the world's biggest health insurance scheme, promising free coverage for half a billion of India's poorest citizens ahead of national elections next year.
Reported by News24 1 day ago.
A New Health Insurance Agreement with Humana Allows Medicare Advantage and Commercial Coverage at Garland Road Nursing and Rehabilitation Center, Serving Garfield County, Oklahoma
ENID, Okla. (PRWEB) September 25, 2018
Garland Road Nursing & Rehabilitation Center and StoneGate Senior Living announces it has secured an agreement for Medicare Advantage and Commercial plans with Humana, effective October 1, 2018.
This new agreement gives the residents and families of Garfield County the opportunity to leverage their Medicare Advantage and Commercial benefits to access Garland Road’s skilled nursing and rehabilitative health care.
“Serving the community of Garfield County is a priority for the health care professionals of Garland Road Nursing & Rehabilitation Center,” says William Martens, administrator, Garland Road Nursing & Rehabilitation Center. “Securing this agreement with Humana for Medicare Advantage and Commercial health coverage means expanded choice and flexibility in care options for seniors and their families.”
About Garland Road Nursing and Rehabilitation Center
Garland Road Nursing & Rehabilitation Center provides premium skilled nursing and rehabilitative care with luxurious accommodations and amenities. The facility offers a diabetes management program as well as inpatient skilled, rehabilitation, outpatient and long-term nursing care
For more information, visit: https://garlandroad.com/
About StoneGate Senior Living
StoneGate Senior Living is an award-winning, full-spectrum senior care and housing company with 44 properties across Texas, Oklahoma and Colorado. Recently ranked as the nation’s 31st largest transitional and long-term care company by Provider magazine, StoneGate is a fully-integrated, post-acute health care company with service-lines and business units that offer transitional care, long-term care, assisted living, memory care, rehabilitation, wellness, pharmacy, care navigation and post-acute analytical services.
Learn more at http://www.stonegatesl.com/. Reported by PRWeb 1 day ago.
Gemphire Therapeutics Inc (NASDAQ:GEMP) stock slumped on Tuesday following its announcement that its board of directors approved a reduction in its workforce by one-third that included letting go of the chief financial officer to cut costs and conserve its cash resources. The decision to cut the workforce was made after the US Food and Drug Administration (FDA) asked for more pre-clinical data to schedule an end-of-Phase 2 meeting for the drug gemcabene to target dyslipidemia indications which would be aimed at elevated plasma cholesterol, triglycerides (TGs), or both, or a low HDL cholesterol level that contributes to the development of atherosclerosis. The workforce reduction as of September 18, 2018, includes five employees representing about 33% of the company’s workforce. Two of the five employees include Jeffrey Mathiesen, the company’s chief financial officer, and Lee Golden, its chief medical officer. READ: Gemphire Therapeutics shares plunge on forced termination of late-stage clinical trial "The workforce reduction is a necessary action to conserve capital. We remain confident in the potential value of gemcabene as a breakthrough therapy for dyslipidemia and are committed to working with the FDA to complete the necessary steps to lift the partial clinical hold,” said Gemphire CEO Steven Gullans. Shares of Gemphire fell almost 5.7% to $2.16, having earlier dropped to a session low at $2. The stock had once traded at a 52-week high of $11.43. As a result of the workforce reduction, the company expects to record severance related charges totaling approximately $1.4 million, which includes one-time cash severance payments of $0.5 million, a non-cash charge of approximately $0.9 million related to the accelerated vesting of outstanding stock options for certain affected employees and $26,300 for continued health insurance coverage. Gemphire is a clinical-stage biopharmaceutical company that is committed to helping patients with cardiometabolic disorders. The company is based in Livonia, Michigan.
Reported by Proactive Investors 1 day ago.
Partnership will support financial advising clients in healthcare planning
NASHVILLE, Tenn. (PRWEB) September 25, 2018
Healthcare advisory firm Bernard Health today announced a new partnership with Baird to provide healthcare planning and health insurance advice to clients of the national financial services firm.
As healthcare costs continue to rise, integrating insurance and healthcare expenses into retirement is an area of significant concern for clients of financial advising and wealth management practices. At the same time, there are few resources available to help individuals and families make the right decisions around health and drug coverage, Medicare, and planning for healthcare needs and costs in retirement.
Through the 12-month Healthcare Extension partnership, Baird’s 900 advisors across the country will have access to Bernard Health’s licensed, noncommissioned healthcare advisors. Bernard Health has more than a decade of experience helping individuals and families compare and enroll in medical coverage, drug coverage, Social Security, and dental and vision coverage, as well as providing advocacy and support in doctor and provider recommendations, medical bill auditing and opening Health Savings Accounts.
“More and more financial advisors all over the country are recognizing that healthcare represents a notable gap in the financial planning process,” said Ryan McCostlin, who leads the Healthcare Extension segment at Bernard Health. “We are impressed by Baird’s leadership and commitment to closing this gap for clients across the country.”
“Based on the strength of a local pilot in Nashville with The Liles Group, we have decided to offer this service to clients nationwide through our national network of advisors,” said Brian Ellenbecker, senior vice president and senior financial planner at Baird. “We are excited to provide expert advice to our clients in an area that is still outside the scope of most financial advising practices.”
Bernard Health launched the Healthcare Extension model through financial advisors in 2017 and has since grown to partner with independent and regional retirement advisors in the Southeast, Midwest and Northeast. The company’s agreement with Baird represents its first corporate-level partnership.
As a result of the growth of this business, Bernard Health is, and plans to continue, adding advisors to support its growing cohort of financial advising partners.
For more information, please visit http://www.bernardhealth.com.
About Bernard Health:
Bernard Health is a fast-growing benefits brokerage and HR software company based in Nashville, Tennessee. The company provides expert advice about health insurance to individuals and employers, and licenses its proprietary HR and benefits administration platform, BerniePortal, to brokers around the country. Bernard Health assists clients with their benefits and HR needs in Nashville, Indianapolis, Austin, and Atlanta, and has broker, provider, and financial advisor partners around the country. Bernard Health’s mission is to be the world’s most trusted advisor when it comes to helping people plan for their healthcare.
Baird is an employee-owned, international wealth management, capital markets, private equity and asset management firm with offices in the United States, Europe and Asia. Established in 1919, Baird has approximately 3,500 associates serving the needs of individual, corporate, institutional and municipal clients. Baird has $211 billion in client assets as of June 30, 2018. Committed to being a great place to work, Baird ranked No. 12 on FORTUNE’s 100 Best Companies to Work For in 2018 – its 15th consecutive year on the list. Baird is the marketing name of Baird Financial Group. Baird’s principal operating subsidiaries are Robert W. Baird & Co. Incorporated in the United States and Robert W. Baird Group Ltd. in Europe. Baird also has an operating subsidiary in Asia supporting Baird’s investment banking and private equity operations. For more information, please visit Baird’s website at http://www.rwbaird.com. Reported by PRWeb 1 day ago.
ISELIN, N.J.--(BUSINESS WIRE)--Amerigroup New Jersey shared the top ranking in the state in the recently released the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2018-2019. In addition, Amerigroup New Jersey was the only Medicaid plan in the state to receive a NCQA Commendable accreditation and Long Term Services and Supports Distinction, an honor that recognizes organizations for coordinating long-term services and supports (LTSS) that deliver efficie
Reported by Business Wire 20 hours ago.
CHARLESTON, W.Va.--(BUSINESS WIRE)--UniCare Health Plan of West Virginia shares top ranking in the state in recently released NCQA Medicaid Health Insurance Plan Ratings 2018-2019.
Reported by Business Wire 20 hours ago.
WASHINGTON--(BUSINESS WIRE)--#NCQA--NCQA's 2018 Health Plan Ratings are out! Ratings tell us how health plans perform in areas of consumer satisfaction, prevention and treatment.
Reported by Business Wire 9 hours ago.
Start with his new tax law–one of the very few laws he actually got through the Republican Congress. Trump said it would likely give every American worker a wage increase of $4,000, but the typical worker’s wages have gone nowhere, which is one reason Republicans have stopped campaigning on the tax law.
Now, Trump wants to use executive action to cut taxes on the rich by an additional $100 billion.
If that weren’t enough, Trump has cut the pay of average workers. His Labor Department repealed overtime protections, at an estimated cost to workers of $1.2 billion in lost wages each year.
Trump and the Republican Congress repealed a rule that required federal contractors with long histories of wage theft, safety violations, and employment discrimination to mend their ways in order to receive any new federal contracts. Now, they can continue to get federal contracts and still shaft their workers.
Trump has also considered cutting back child labor protections in hazardous jobs. His other regulatory rollbacks would expose working families to pollutants in drinking water and reverse decades of work to finally ban asbestos.
Trump’s pick for the Supreme Court, Brett Kavanaugh, has even argued that the government has no authority to protect the health and safety of workers in sports and entertainment, even though the government has long regulated safety in the entertainment industry.
Oh, and remember Trump’s promise to replace the Affordable Care Act with something better? Well, you can forget that one, too. Instead, Trump has done everything he can to undercut the Act, resulting in an anticipated near 20% increase in health insurance premiums, and the biggest burden falling on working families who earn too much to be eligible for subsidies.
As a result of Trump’s undermining of the Affordable Care Act, the number of Americans without health insurance rose by more than 3 million in 2017, after years of declines following the implementation of the Act.
Trump’s most recent budget proposal skewers working people with a proposed $763 billion cut in Medicaid and other health programs, $494 billion of cuts in Medicare, and major cuts in education and nutrition over the next 10 years.
Trump has betrayed the working class – but he still claims he’s on their side. That’s one of his biggest lies of all. Reported by Eurasia Review 11 hours ago.
According to an expert from TISS, the low 2018-19 budget for PMJAY was the fundamental flaw with the health insurance scheme under Ayushman Bharat.
Reported by Firstpost 11 hours ago.
The largest HR Summit event in Indonesia, The 10th Indonesia HR Summit 2018 (IHRS 2018), was successfully held on September 17-18 2018 at the Nusa Dua Convention Center, Bali
JAKARTA, Indonesia, Sept. 26, 2018 /PRNewswire/ -- PT. Avrist Assurance who was present as the Official Insurance Partner at this event gave their support by providing insurance protection to all participants from various cities in Indonesia who attended this prestigious event. Avrist provides a maximum protection of IDR 75 million for Personal Accident where they will be protected for the next 30 days since the event started. The participants will get an e-policy that will be sent directly to their personal email at the time they registered.Indonesian Finance Minister Sri Mulyani was one of the speakers at The 10th Indonesia HR Summit 2018 in Bali.
IHRS 2018 is an important forum for HR professional from various industries to discuss how to face the challenges and business opportunities in the current technological era to be globally competitive. Bringing up the theme "Humanizing Technology in Managing Tomorrow People", the summit discussed how technology is adaptable with the current trends, characters, and needs in managing future workforce and aims to harmonize communication, connection, network, and interaction between individual and corporations.
The event was attended by approximately 800 participants, dozens of speakers including Indonesian Finance Minister Sri Mulyani, President Director of Medco Energy Hilmi Panirogo, President Director of PT Pertamina Nicke Widyawati, Founder & CEO Bukalapak Achmad Zaky, President Director of PwC Consulting Marina Tusin, and several exhibitors from sponsors and partners.
The support of Avrist by providing insurance protection in IHRS 2018 is one of their commitment realizations to contribute on the development of resources quality in Indonesia amid the growing digital technology these days.
PT Avrist Assurance (Avrist) is the first joint venture life insurance company in Indonesia that has been established since 1975 under the name of Asuransi Jiwa Ikrar Abadi (AJIA). Avrist Assurance continues to grow into one of the leading life insurance companies that can compete in the life insurance industry in Indonesia. With more than 40 years of experience, Avrist has developed several distribution channels including Agency, Bancassurance, Employee Benefit and Sharia which provides life insurance, accident and health insurance, sharia insurance, credit life insurance and pensions both for individuals and corporations. Avrist presents in 23 cities with more than 400 employees, supported with more than 2,000 certified agents and cooperating with more than 850 hospital partners in Indonesia to serve the customers.
In 2010, Avrist partnered with Meiji Yasuda Life Insurance Company, one of the life insurance market leader in Japan with over 130 years of experience. In line with its development, Avrist Assurance now has 3 subsidiaries there are Avrist Pension Fund, PT. Avrist General Insurance, and PT Avrist Asset Management.
With the vision "One Policy for every household in Indonesia", Avrist is committed to advance a rewarding life for its customers, business partners and also its employees.
PT Avrist Assurance are registered and supervised by Otoritas Jasa Keuangan.
*For more information**:*
Corporate Communications PT Avrist Assurance
Gedung World Trade Center II Lt. 7
Jl. Jenderal Sudirman, Jakarta 12920
t: +62 21 5789 8188
Photo - https://photos.prnasia.com/prnh/20180926/2247498-1
Related Links :
http://www.avrist.com Reported by PR Newswire Asia 9 hours ago.
America and Americans continue to struggle with access to affordable healthcare. Whether the solution is multi-payer private, single-payer, integrated delivery or a new model entirely, sustainability will only be achieved when the interests of patients, providers, payers and employers are all aligned.
LAFAYETTE, Calif. (PRWEB) September 26, 2018
Across the United States, there is one issue of common concern to most Americans - In almost every survey on issues of concern to Americans, the availability and cost of healthcare is at the top of the list. As healthcare costs continue to rise, better solutions are being sought and new models are evolving - all with the goal of delivering high quality and effective healthcare at a reasonable cost. In this article, we’ll examine models for the delivery and payment of healthcare in modern, industrialized economies, and explore the dynamics that are driving fundamental change here in the U.S.
In the United States, healthcare has always been an adversarial arena for participants – providers, payers, clinicians, administrators, employers and patients. The economic incentives for each of these constituencies do not align. The payer insurance company is focused on controlling costs and managing premiums, the provider is focused on the best possible care at any cost, the employer is looking to manage its expenses and exposure to risk, and the patient just wants to get well without incurring unbearable personal expense.
Historically, the economics behind the American healthcare industry have wrongly incentivized volume-based fees-for-service over value-based care delivery at a mounting cost to the American economy, costs that affect every stakeholder. Consequently, payers, providers and patients are all looking at new models to achieve high quality health services at “reasonable costs.”
Incremental adjustments to the U.S.’s traditional multi-payer model are being attempted, but so far they have fallen short of meeting the objectives for a sustainable, affordable healthcare delivery and payment model.
Matt Bierbaum, VP of Managed Services and Enterprise Partnerships at Philips stated that “With (the market’s) revised expectations for quality and value comes a need for higher degrees of coordination and new models of strategic partnership among all participants in the healthcare economy. Many hospitals, payers and community organizations are already finding ways to work together as partners to deliver new care delivery options or payment choices to patients. However, in most of these "partnership" arrangements, the parties are simply trading better long-term prices or more broadly scoped service and purchasing agreements. While these types of collaborations can make near-term incremental improvements, they are still not aligned to meet the long-term challenges of the new healthcare economics”.
A Comparison of Healthcare Financial and Delivery Models
Multi-Payer System - The American Model
The United States has no single nationwide system of health insurance. Health insurance is purchased in the private marketplace or provided by the government to certain groups. Private health insurance can be purchased from various for-profit commercial insurance companies such as United Healthcare or from nonprofit insurers such as Blue Cross/Blue Shield. Approximately 61% of health insurance coverage is employment related, largely due to the cost savings associated with group plans that can be purchased through an employer.
The United States possesses a multiplayer system in which a variety of third - party payers are responsible for reimbursing health care providers. Thus, we face the first disconnect, where the insurance company is focused on reducing patient care outlays and the provider is focused on delivering the highest quality of patient care which, coincidently, generally increases the profit of the healthcare provider whether that provider is a doctor, hospital or pharmaceutical company.
In addition to private health insurance, nearly 26% of the U.S. population is covered by public health insurance. The two major types of public health insurance, both of which began in 1966, are Medicare and Medicaid. Medicare is a uniform national public health insurance program for aged and disabled individuals. Administered by the federal government, Medicare is the largest health insurer in the country, covering about 13% of the population.
According to the Kaiser Family Foundation's survey of employer health benefits, health insurance premiums have been rising faster than wages. Between 2012 and 2017, workers' earnings grew by 12 percent, while premiums went up by 19 percent. Between 2007 and 2012, premiums increased twice as fast as workers' earnings.
Former Apple CEO John Sculley, now the chief marketing officer for RxAdvance, a health tech company, has observed that “The U.S. health-care system is unsustainable in terms of its costs, and the entire debate by political leaders — whether it is Democrats or Republicans — has focused on repairing and replacing Obamacare and the ideological differences.”
Single Payer - Government Sponsored Systems
A single-payer system is a single public system that covers the costs of essential healthcare for all residents. It is this characteristic that distinguishes most of the industrialized world’s systems from the United States’ multi-payer system in which private, qualified individuals or their employers pay for health insurance with various limits on healthcare coverage via multiple private or public sources.
Single-payer systems (also referred to as socialized medicine) may contract for healthcare services from private organizations (Canada) or may own and employ healthcare resources and personnel (United Kingdom). These systems generally fall within one of three models: The Beveridge Model (UK) the Bismarck model (Germany), and the National Health Insurance Model, which contains elements of both the Beveridge and Bismarck models.
In any of these three models, healthcare providers and consumers deal with a single, governmental payer, which may own and operate its own healthcare delivery system, or may engage with private healthcare providers and payers with powerful government oversight. In each instance, universal coverage is assured with costs and care delivery closely managed by the government entity charged with the system’s administration. The programs are funded either by taxes (Beveridge), Employer/Employee private insurance (Bismarck) or Government run insurance (National Health)
The lower costs and universal coverage provided by many single payer systems have led to successful employer-sponsored experiments here in the U.S. At present, it may be these or similar models that prove to be the solution to America’s seemingly intractable healthcare challenge.
Privately funded, multi-payer systems: Managed Care – an Integrated Delivery System (IDS)
An Integrated Delivery System (IDS) is a health system with a goal of logical integration of the delivery of health care rather than a fragmented system or a disorganized lack of system. The term has sometimes been used in a broad sense with reference to Managed Care in general (as opposed to fee-for-service care), but in the United States it now more often refers to any specific network of health care organizations constituting a corporate group that attempts to integrate care to some degree.
One of the most successful of the Managed Care systems in the United States started during World War II.
In 1942, 20,000 Kaiser Shipyard workers were provided healthcare services through the Kaiser Permanente Health Plan. Workers paid a very small premium (6 cents a day) and healthcare was provided at the job site, thereby minimizing healthcare costs and improving healthcare services to workers. Last but not least, it also reduced employee absence time through on-the-spot healthcare services. Kaiser Permanente has remained a very large and successful healthcare delivery model, combining the services of a payer and provider across several states.
Today, other efficient integrated healthcare systems generally are found in large multi-specialty medical group practices with transparent links to hospitals, labs and pharmacies. These organizations provide complete care—from the doctor's office to the hospital to home care, and everything in between. They often have their own insurance arms and work under contracts in which they agree to deliver comprehensive medical services to consumers for a fixed-dollar amount.
The relative success of a Managed Care model evolves around two propositions:
1. The system has moved from a linear structure to a closed-loop model. In traditional models, care and costs associated with equipment, services, and software are considered as separate, isolated events at every step in each patient’s journey. In the Managed Care model, there is full transparency providing visibility to the all players in the continuum of care.
2. Partners share risk (and reward) for outcomes. This is a particularly critical component as our healthcare market shifts from a volume- to value-based model. In the most innovative business models, risk (financial, clinical or operational) is appropriately distributed to each partner to ensure a shared focus and contribution to the joint goals of the partners.
Strategies to mimic the Managed Care Model in Traditional Care Delivery Environments
Due to the success of Kaiser’s and other Managed Care models, many hospitals and health systems are making merger and acquisition moves to implement value-based care, manage costs and sustain profitability. It’s easy to see why. According to a 2016 HFMA report, “The transition from volume to value and the corresponding move to population health management require major capital investments and sophisticated management expertise of the sort that may prompt even the most independent-minded hospitals and health systems to consider their consolidation options.”
The Managed Care model has recently accelerated in growth as the result of the dramatic increase of mergers and acquisitions across industry verticals. Payers (insurance companies) have entered the provider (hospital business) and drug store companies have acquired payers.
These companies are moving into an industry where the lines between traditionally distinct areas, such as pharmacies, insurers and providers, are increasingly blurry. CVS Health’s deal to buy the health insurer Aetna for about $69 billion is just one example of the changes underway. Separately, Amazon’s potential entry into the pharmacy business continues to rattle major drug companies and distributors.
An Evolving Fourth Model
During the last two years, a new model has emerged, the result of employers tackling the problem of healthcare accessibility and cost. Employers are using their considerable purchasing power to influence provider and health plan behavior and discovering new means to control healthcare costs. If implemented, these initiatives would help inaugurate the transformation critical to the industry's financial survival.
Many large employers are now negotiating payments to providers based on the value of the services provided. They’re also offering incentives and information for consumers to allow them to choose high value providers thereby aligning private purchaser actions with public purchasers’. Leveraging their market and cultural influence, these employers are, in effect, applying the same economic pressures wielded by government payers in single-payer and our own Medicare/Medicaid systems.
Recently three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced that they would form an independent health care company for their employees in the United States. The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies.
Will more companies adopt an Amazon - Berkshire Hathaway -JP Morgan Chase model? Or will they join the model where the employer is the payer and provider of healthcare services? Will the Amazon triumvirate begin to acquire hospital systems, pharmaceutical companies and healthcare technology providers?
Does the Model Really Matter?
Essentially, this is a question without an answer. Each model has its benefits and costs. Single payer proponents will argue that the United States should adopt this model and follow the European model. The American model delivers choice and convenience. The Managed Care model is efficient and comprehensive and the new evolving Amazon model is untested.
Whatever the model, payers, providers and patients can work together to build a better “mousetrap” by focusing on several key objectives and solutions:
Patient Level Initiatives:· Simplify and standardize health care administration, such as codes and billing, across health care industries.
· Offer incentives for processes that improve patient care such as electronic health records.
· Streamline the Patient Registration Process.
· Together with the patient, create a Custom Patient Financial Plan.
· Incorporate Estimated Patient Share financial tools into the patient financial management process.
· Incorporate a Patient Financial Assessment into the registration process.
· Incorporate Estimated Patient Share financial tools into the patient financial management process.
· Consolidate and democratize patient medical and financial information
· Ensure that information technology enables self-management by improving patients’ access to personal health information.
Provider and Payer Level Initiatives:
· Implement comparative effectiveness studies for treatment practices.
· Develop a national initiative to reduce preventable hospital admissions and readmissions.
· Expand hospice through support to community-based programs.
· Reduce relative values for services undergoing high rates of growth in volume.
· Promote bundled payment covering all providers for acute episodes of care and post-acute care.
· Fund research to identify key elements of effective self-management programs.
· Support self-management through benefit design such as using financial incentives for patients to encourage the use of care that is proven to be effective and discourage care that has less evidence of success.
· Support self-management through provider incentives, linking payments to increases in patient activation.
· Ensure that information technology enables self-management by improving patients’ access to personal health information.
· Promote provider support for patient-centered care.
Organizations are seeking new capabilities for a value-based, consumer-oriented health system. These capabilities include data analytics and care coordination across the healthcare continuum. Whatever the model or initiative, the patient must remain at the center of the discussion. Quality service at a reasonable cost is achievable under any model if we can move healthcare out of the political discourse and begin to change the adversarial arena of the participants to one of mutual benefit and cooperation.
Kevin Fleming is the CEO of Loyale Healthcare, LLC.
About Loyale Healthcare
Loyale Patient Financial Manager™ is a comprehensive patient financial engagement technology platform leveraging a suite of configurable solution components including predictive analytics, intelligent workflows, multiple patient financing vehicles, communications, payments, portals and other key capabilities.
Loyale Healthcare is committed to a mission of turning patient responsibility into lasting loyalty for its healthcare provider customers. Based in Lafayette, California, Loyale and its leadership team bring 27 years of expertise delivering leading financial engagement solutions for complex business environments. Loyale currently serves approximately 2,000 healthcare providers across 48 states. Loyale recently announced an Enterprise level strategic partnership with Parallon including deployment of its industry leading technology to all HCA hospitals and Physician Groups nationwide. Reported by PRWeb 7 hours ago.
The partnership will provide Aetna Medicare Advantage members access to Oak Street Health’s three new primary care centers in the Cleveland area.
CLEVELAND (PRWEB) September 26, 2018
Oak Street Health, a network of primary care centers providing a new model of value-based primary care to Medicare patients, and Aetna (NYSE: AET) have entered into an innovative value-based network agreement in Cleveland. Effective today, Aetna Medicare Advantage members and retirees that receive coverage through Aetna Group Medicare Advantage plans will have access to Oak Street Health’s three new primary care centers.
“We’re proud to bring our proven model of preventative, personalized care to Aetna members in Ohio,” said Brian Clem, president of Oak Street Health Indiana and Ohio. “Aetna is a trusted partner, and we look forward to deepening our relationship and improving outcomes for nearly 23,000 Aetna members, together.”
Oak Street Health's community-based care model focuses on the overall value of health care for its patients. Its facilities feature more comprehensive services than a traditional doctor's office. These include 24-hour access to a physician, flexible scheduling, more face time with doctors, community health and wellness events, state-of-the-art technology and a dedicated care team to coordinate all health needs. This proven strategy has reduced Medicare hospitalizations in other Oak Street facilities by more than 40 percent.
“Aetna is a leader in providing our members innovative ways to access care, enabled by strong provider collaborations that encourage high-quality care delivery,” said Charles Brown, general manager for Aetna Medicare’s Ohio and Kentucky Markets. “By working together with Oak Street Health, we will be able to collectively continue to deliver improved outcomes and an enhanced experience to our Medicare members, meeting them in their communities where many of the conversations between patients and providers occur.”
Three locations are scheduled to open beginning in September through the end of 2018. Centers are located at:· Glenville: 10553 St Clair Ave. Cleveland, OH 44108
· West Boulevard: 10688 Lorain Ave, Cleveland, OH 44111
· Lee-Harvard: 4071 Lee Road Cleveland, OH 44128
To learn more about Oak Street Health’s value-based primary care model and the latest openings in the Cleveland area, visit https://www.oakstreethealth.com.
About Oak Street Health
Oak Street Health is a rapidly growing company of primary care centers for adults on Medicare in medically underserved communities. Oak Street’s care is based on an entirely new model that is based on value for its patients, not on volume of services. The company is accountable for its patients’ health, spending more than twice as long with its patients and taking on the risks and costs of their care. Oak Street Health has been investing in communities since 2013 – providing much-needed primary care for tens of thousands of people.
Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 38.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see http://www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Other physicians/providers> are available in our network. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Reported by PRWeb 4 hours ago.
OLDWICK, N.J.--(BUSINESS WIRE)--While more than half of property/casualty (P/C) and life/health insurance companies surveyed on innovation view it as extremely or very critical to their organization’s future success, respondents to an A.M. Best survey also believe these segments need to make greater strides in this area. Life products require a more active salesmanship and longer durations, leaving the segment less driven to make abrupt shifts in product offerings. P/C writers have used technol
Reported by Business Wire 3 hours ago.
Research from OnePoll and Lendio shows that nearly 80 percent of entrepreneurs say they would take on more business debt in order to surmount the barriers to success
SILICON SLOPES, Utah (PRWEB) September 26, 2018
Seven in ten small business owners feel the American dream is harder to reach than ever before, according to a new survey conducted by OnePoll in conjunction with Lendio. The new survey of 2,000 small and micro business owners examined the challenges of owning and operating a business and found that close to three quarters (72 percent) feel the old-fashioned dream is harder to achieve than it was, while a third (35 percent) say it’s a lot harder. Business owners reported economic uncertainty, hiring talented employees and general financial concerns as the top three barriers to attaining the American dream.
Seventy-eight percent of the entrepreneurs polled said raising capital and the ability to expand are essential to achieving the dream, and they would gladly take on more debt in order to achieve it. A further 15 percent would take on “a lot” more debt to surmount the barriers to success. Yet nearly half of the survey respondents (48 percent) say the funding ecosystem around small business is broken. Only 40 percent of respondents felt they were able to borrow as much money as they wanted for their business, with 35 percent saying they feel financially underserved as a small business owner.
Taking risks is another point of interest for small business owners, with nearly half (46 percent) agreeing it would have benefited their business if they had taken more risks early on. And while 78 percent believe you can maintain a business by bootstrapping and self-financing, nearly three in four respondents (71 percent) said that taking on loans and debt can lead to more growth down the line.
“Most small business owners take a great deal of pride in bootstrapping their operations from the ground up, and rightly so,” said Brock Blake, CEO and founder of Lendio. “But savvy business owners also understand that a smart, proactive approach to taking on financing can catapult their success. These businesses are better able to support innovation, take advantage of growth opportunities and keep their doors open during tough times.”
The average small business owner has taken on $72,271 in loans for their business, with one in four (23 percent) saying they’ve taken on even more than that. The poll also revealed that small business owners are more comfortable taking on business debt than personal debt, with respondents nearly twice as likely to say they’d take on business debt if it meant future growth. When asked how they currently fund their small business, personal funds came out on top, with 77 percent, followed by bank loans (34 percent), and borrowing money from friends and family (16 percent).
“Unfortunately, many small business borrowers tend to be bank-loyal to a fault. While the majority of business owners want small-dollar loans and need access to funds immediately, banks are not equipped to serve them in this way,” said Blake. “Business owners need to know they have options. Online lenders with streamlined application processes are making it easier than ever to get funds for your growing business.”
Key findings from the survey include:
TOP 9 WAYS SMALL BUSINESS OWNERS FUND THEIR BUSINESS· Personal funds 77%
· Bank loan 34%
· Borrowing from family/friends 16%
· Other funding 11%
· Donations from family/friends 9%
· Online lender 4%
· Angel investor 3%
· Venture capital 3%
· Crowdfunding 2%
TOP 10 CHALLENGE SMALL BUSINESS OWNERS FACE
· The economy 40%
· Hiring talented employees 38%
· Finding/retaining customers 35%
· Money issues 31%
· Health insurance for employees 30%
· Government regulations 30%
· Trying to do it alone 28%
· Lack of time 26%
· Understanding tax code 23%
· Staying current 21%
TOP 10 ELEMENTS OF THE MODERN AMERICAN DREAM
· Homeownership 48%
· Freedom to live how you please 48%
· Starting your own business 29%
· Having minimal debt 29%
· Retiring eventually 24%
· Becoming wealthy 20%
· Having a job in the field you went to school for 18%
· Graduating college 16%
· Having children 11%
· Upward social mobility 11%
For more information about Lendio, visit http://www.lendio.com.
Lendio is a free online service that helps business owners find the right small business loans within minutes. With a network of over 75 lenders offering multiple loan products, Lendio’s marketplace is the center of small business lending. Bringing all options together in one place, from short-term specialty financing to long-term, low-interest traditional loans, our technology makes small business lending simple and decreases the amount of time and effort it takes to secure funding. For every loan facilitated on Lendio’s marketplace platform, Lendio Gives, an employee contribution and employer matching program, donates a percentage of funds to low-income entrepreneurs around the world through Kiva.org. More information about Lendio is available at http://www.lendio.com. Information about Lendio franchising opportunities can be found at http://www.lendiofranchise.com. Reported by PRWeb 9 hours ago.