What Fraud and Abuse Has Cost Healthcare, How & How Much AI Can Save the Industry From It
April 19th 2023In this final part of a two-part video series, Clay Wilemon, CEO of 4L Data Intelligence, shared how much in cost that fraud, waste and abuse has affected healthcare due to issues like overpayment; and how leveraging your artificial intelligence can help solve fraudulent issues. Clay added how much the industry can save using these solutions.
Watch
Yoona Kim, PharmD, PhD, co-founder, CEO of Arine Inc., talked about the relationship between racial health disparities and medication non-adherence, and how artificial intelligence can help improve adherence between groups most affected such as Black, Latino and Asian populations.
Watch
Sharon Jhawar, Chief Pharmacy Officer at SCAN Health Plan, said the organization researched their health plans to figure out what inequities existed in their members. What stood out was that their quality was lower for Black members and they weren't meeting their needs. They also saw in medication adherence, a significantly lower percentage of their Hispanic and Black members who were non-adherent. With the help of AI and cultural matching patients with physicians, they have noticed the improvement of adherence from their patients.
Watch
Jane F. Barlow, MD, MPH, MBA, chief clinical officer of Real Endpoints led a presentation at the annual AMCP meeting that can help align payers and their manufactures for success in value-based contracting. In this interview Barlow gives some insight on where we are now with value-based contracting compared to a few years ago and if it's gained some traction or if there are challenges that remain. She also touched what therapies are prime candidates for value-based contracting.
Watch
Melissa Andel of CommonHealth Dives Into the Inflation Reduction Act & What May Come at AMCP 2023
March 24th 2023Melissa Andel of CommonHealth Solutions spoke at the AMCP annual meeting today in San Antonio about the ins and outs of the Inflation Reduction Act. She shared her discussion highlights the Act's plans of cost shifting in healthcare and the Medicare part-D benefit re-design. In this interview with Managed Healthcare Executive, Andel addressed the Eli Lilly $35 Insulin cap and how plans of price negotiation will resonate with the public. She also expressed what we may expect through Congress when it comes to repealing any provisions through the IRA, and what could be coming through inflation penalty rebates.
Watch
Ben Urick, PharmD, PhD, Health Outcomes Research Principal at Prime Therapeutics, LLC, discussed how non-adherence to medication has lead to medical cost offsets and shared solutions to improve adherence from patients and providers. In particular, Urick shared best data-collecting practices that can in-turn improve both adherence and cost. Urick led a discussion on the challenges leading to non-adherence and shared the efforts underway to remove them at the annual AMCP meeting in San Antonio.
Watch
Magellan Team Discusses 'Mortgage-like' Payments For Ultra-Expensive Gene Therapies | AMCP 2023
March 23rd 2023When asked for solutions in better managing expensive drug costs, Michelle Booth of Magellan suggests a "mortgage-like" payment that could help make these therapies, which are covered under medical benefits, more accessible and affordable. Because there aren't many gene therapies out there just yet in the market, there hasn't been much pressure in offering discounts through value-based contracts to patients. Though, more discussions on this initiative are happening, Andy Killpack also of Magellan, said in the second-part of a two part AMCP annual meeting video series.
Watch
Magellan's Michelle Booth and Andy Killpack presented today at the annual AMCP meeting in San Antonio to discuss equitable access to recombinant adeno-associated virus (rAAV) gene therapy as there are currently many barriers patients face toward treatment. Booth, senior director of specialty clinical solutions, claims though cost plays a significance in access, there are much more barriers from education to income that lead to inequities. Killpack and booth share solutions and other gene therapies expected to come to market.
Watch
Reinsurance, Stop-Loss Programs in Managing High-Cost Meds, Per Rick Lassow of Summit Re | AMCP 2023
March 23rd 2023At the annual AMCP meeting, Summit Re's Vice President of Actuarial & Underwriting, Rick Lassow, FSA, MAAA, led a discussion on managing high-cost medications through reinsurance and stop-loss programs. In this interview with Managed Healthcare Executive Lassow addresses high-cost cell and gene therapies ran through reinsurance and how Medicaid can benefit the most from reinsurance programs.
Watch
Kimberly Westrich, MA, Director of Value & Access Strategy at Xcenda/AmerisourceBergen kicks off AMCP's 2023 annual meeting in San Antonio with her discussion on value framework assessments. Westrich mentioned one of the obstacles payers come across when using value assessment frameworks in decision-making is either not having enough information or having the right kind of information.
Watch