About Us - Managed Healthcare Executive
WEBhome / about. Managed Healthcare Executive ® is the leading resource for payer decision-makers. We provide industry news, market trends and peer-inspired insights about improving outcomes, enhancing the patient experience and lowering the cost of care. We are source of timely, accurate information about value-based care, cost-effectiveness ...
How Capitation Contracts Benefit Providers, Payers and Patients
WEBMay 11, 2023 · Capitation contracts can benefit providers, payers, and patients. But they require thoughtful planning, careful alignment between PCPs and specialists, a commitment to optimizing the patient/member experience within a narrower network of providers, and a robust digital infrastructure. Lynn Carroll is the chief operating officer of HSBlox, an ...
PBMs are Creating GPOs, and Stirring Debate as to Why
WEBJul 12, 2022 · PBMs are Creating GPOs, and Stirring Debate as to Why. The Big Three all set up group purchasing organizations recently, but some industry observers question the timing of the move and who will benefit. In 2019, Express Scripts PBM (pharmacy benefit manager) formed Ascent Health Services GPO (group …
Five things to know about the role of GPOs in the healthcare …
WEBSep 14, 2017 · Based on our analysis, the following are 5 things to know about GPOs, their business model and role in the supply chain, and their impact on healthcare costs and competition: 1. GPOs source and negotiate prices for products and services. GPOs help source and negotiate prices for drugs, medical devices, and other products and services on …
Beyond the Big Three PBMs - Managed Healthcare Executive
WEBDec 19, 2022 · But beyond the big three PBMs is a swarm of some 60 smaller, up-and-coming PBMs. Even if they are operating in a small slice of the pie relative to the towering dominance of the big three, the PBM pie is growing rapidly. The global PBM market is projected to increase from $495 billion in 2022 to $740 billion by 2029 (a 50% jump), according to a ...
Copay assistance programs: Managed care pros and cons
WEBOct 25, 2016 · Copay assistance programs diminish the tradeoff companies face between setting a higher price and selling more product.”. These programs reduce the ability of insurers and PBMs to use cost sharing to steer patients to preferred drugs, according to Howard. David Weingard, CEO of Fit4D, a patient …
10 Ways to Improve the Patient Experience - Managed Healthcare …
WEBMay 20, 2019 · Improving the patient experience is a goal that makes sense for every healthcare provider. “The evidence continues to show that organizations that focus on patient experience drive outcomes: financial, loyalty, and clinical outcomes,” says Sam Hosokawa, vice president patient experience at Children’s Healthcare of Atlanta.
FDA Approves New Pompe Therapy - Managed Healthcare Executive
WEBSep 29, 2023 · The FDA has approved a two-component therapy — Pombiliti (cipaglucosidase alfa-atga) with Opfolda (miglustat) — to treat adults living with late-onset Pompe disease. It is indicated for those who are not improving on enzyme replacement therapy. Late-onset Pompe disease is a rare, debilitating, and life-threatening disease that is caused by a deficiency of the enzyme acid alpha-glucosidase ...
6 Strategies for Your Hospital Readmissions Reduction Program
WEBSep 12, 2019 · Payment reductions are calculated by subtracting the PAF from 1.0 and multiplying by 100. So for example, a hospital with a PAF of 0.975 would have a payment reduction of 2.5%: 1.0 - 0.9750 = 0.025 x 100 = 2.5% reduction. Since the program began, CMS has doled out $2.5 billion in penalties, with an …
Building Successful Payer-Provider Partnerships for Cost Reduction
WEBNov 11, 2014 · With U.S. annual healthcare spending[1] at nearly 18 percent of Gross Domestic Product and now topping $3.8 trillion, the need to reduce medical costs is critical. Many successful cost reduction strategies such as new payment and delivery models focus on hospital-physician alignment. Equally important, however, is aligning the two biggest players – hospitals and payers – in a way that ...