Payers recognize a growing need for more comprehensive payment methodologies that adequately represent the true market cost of health services today.
As the healthcare industry undergoes unprecedented change, particularly in regard to payment reform, payers recognize a growing need for more comprehensive payment methodologies that adequately represent the true market cost of health services today.
Related:HHS announces historic changes to Medicare
Providers who have traditionally based their payment methodologies on a multiple of Medicare’s fee schedule are beginning to recognize inherent limitations in a Medicare-based schedule that can affect their bottom line. Luckily, many limitations can be addressed by integrating independent, market-based data into a payment schedule. For example:
To remain viable in this changing healthcare environment, payers of all types will need to make thoughtful, well-informed decisions about their reimbursement methods. Robust, reliable, and relevant data are the key to building a payment model that appropriately compensates healthcare providers.
Joel V. Brill, MD, is the medical director for FAIR Health, Inc., a national, independent, nonprofit corporation whose mission is to bring transparency to healthcare costs and health insurance information.
In this second part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein spoke with CeCi Connolly and Margaret "Meg" Murray about Medicare Advantage utilization and challenges, highlighting proposed CMS payment cuts and prior authorization issues.
Listen
New approvals this week include a $4.25 million gene therapy, a drug that treats hypertension in a new way, a nonsteroidal drug for Duchenne, and an oral drug for aggressive leukemia. The agency has set an action date for resubmitted Lymphir in rare skin cancer, and Celltrion has launched Zymfentra, a subcutaneous form of infliximab.
Read More
In this first part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein kicks off our new podcast series "DC Roundtable," with guests Margaret "Meg" Murray, CEO of the Association of Community Affiliated Plans, and member of MHE's Editorial Advisory Board, and CeCi Connolly, president and CEO of the Alliance of Community Health Plans, for a discussion on healthcare policy issues.
Listen