Business Strategy

Legislation that would establish benefit categories for digital therapeutics has been introduced in Congress.

To thrive organizations must figure out how to build and maintain a strong culture in an increasingly remote workplace, and implement effective recruitment and retention strategies in an economy where there are fewer workers.

If biosimilar acceptance is to grow, it’s going to take a great deal of work to improve the levels of trust between payers, patients, and oncologists.

The review, partly funded by Amgen, the maker of Riabni, makes the case for using the biosimilar to Rituxan for all indications of the originator.

The guide is designed to help spread best practices and help healthcare decision-makers understand the benefits of digital therapeutics.

Pharmacy benefit managers can help health plans understand when to best leverage and align to biosimilars and other cost-effective treatments, argues Prime Therapeutics' Kelly McGrail-Pokuta.

A recent HHS Office of Inspector General's report found that Medicare Advantage (MA) plans inappropriately deny prior authorization requests. With MA enrollment growing, scrutiny of MA plans and their utilization management strategies is also likely to grow, according to Alina Czekai, M.P.H., of Cohere Health. Czekai argues that artificial intelligence and machine learning can improve utilization management and prevent inappropriate denials.

In their general session, Adam J. Fein, PhD of Drug Channels Institute, and Doug Long of IQVIA reviewed the current specialty pharmacy space, ongoing trends and future expectations.

Accurate data and comprehensive analysis enable health plans and healthcare providers to advance the safe use of medication.

Significant changes to Star Ratings are in store for 2023, which will directly impact health plans in many ways. For example, their ability to market to members year-round. Included are three things health plans should act on now to maintain or boost quality scores, plan growth and retention, and financial health.

Patient deductibles are likely to continue rising in coming years, and healthcare providers will have to implement strategies to continue providing patients with the best possible care.

As of early this year, as many as 23 million Americans may have developed long COVID, in which symptoms persist four or more weeks after first being infected with the virus. The condition is likely to have additional long-term effects that are not yet clear. However, the U.S. has begun to obtain a glimpse of long COVID’s far-reaching impact on those who suffer from it - and the picture is rather disturbing.

As personalized medicine grows, so does the need for specialized management of laboratory testing.

Patients are likely to continue to choose to recover at home rather than go to skilled nursing facilities, according to a new report by Trella Health.

There is no lack of available COB solutions on the market, and the trouble is often identifying which option is the best fit for your organization. For optimal results, look for the following six elements in a COB solution to have the most success.

Equity is a central part of healthcare quality, but health plans often lack information on individual members’ race and ethnicity, making assessing and improving health outcomes challenging.

As the industry becomes oriented toward value-based care and its focus on high-value outcomes, utilization management must evolve to address the entire patient care journey, often across multiple episodes of care.

Tagged with the moniker "late retirees," this group of Medicare first-timers isn’t ready to call it quits. How can you help them? Find out below:

A recent study found 70% of patients believe remote patient monitoring enables better care management.

With the COVID-19 pandemic ongoing and alarming levels of healthcare workers still experiencing stress, burnout, and other negative feelings surrounding their work, it's time to return the favors they've given countless others.

Hiring assistants that work virtually and outsourcing medical coding are two ways that providers can navigate through these times of increasing cost pressures and staffing shortages.

Medicare and Medicaid programs that serve the most-vulnerable Americans facing SDOH barriers can be major facilitators of appropriate non-emergency transportation to non-medical sites. But how do we determine what is appropriate, and what do we know about transportation services to non-medical sites today?

There is a bias in this country against people whose medical condition is perceived to be “their fault”– in other words, the result of their own lifestyle choices. To combat stigma and its harmful effects, there needs to be broader understanding, even among medical professionals.

A look inside six trends that will shape and influence care, planning and performance over the next year for health plans.

The true key to achieving high savings, more patient volume, and better health outcomes is to effectively use clinical and cost data with physicians to create interventions that improve performance.

Many have claimed that technology will be the great equalizer in healthcare. While technology is objective and purely data-driven and without prejudice, there can still be inherent biases that hamper the ultimate goal of health equity.

Hospital leaders who have historically viewed price transparency as potentially disastrous can tap into these three tips to leave that mindset behind and capitalize on the opportunities that price transparency provides.

Despite advances in medical science and technology, our healthcare system doesn’t always translate knowledge into practice. All too often, this leaves healthcare providers questioning the key business decisions that impact patient care. What caregivers need is a model for applying new technology safely and appropriately. Thankfully, such a model exists: the High Reliability Organization (HRO) model.

For health insurance executives, pursuing the Quadruple Aim is the name of the game.