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 …
‘Hybrid Health’ Opens up Opportunities and Exposes Gaps in …
WEBFeb 16, 2022 · It is not about digital replacement of in-person healthcare, but layering in tools and services that allow for remote care and give patients (and their families) options. “A hybrid model enables both convenience and cost-effective healthcare through telehealth while still providing vital face-to-face care when appropriate,” Baethke says.
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 ...
Five ways to close gaps in care and build a successful quality ...
WEBJan 8, 2017 · Face-to-face contact is the number one tool to close gaps in care, outranking mobile apps, patient portals, social media, or surveys. Timely and actionable quality scorecards also demonstrate to providers where the gaps in care are for their patients. Physicians should be engaged in how the scorecards are …
Understanding North Carolina’s Healthy Opportunities Pilots
WEBOct 6, 2019 · Historically, Medicaid funds were not able to be used to pay for non-medical interventions that target the social determinants of health. But last October, CMS approved North Carolina’s Section 1115 waiver which provides financing for a new pilot program called “Healthy Opportunities Pilots,” designed to cover evidence-based non-medical services that address specific social needs linked ...
7 Skills Healthcare Executives Need to Succeed
WEBSep 23, 2020 · As a result, healthcare executives need to be transparent in a way that is more real than ever. For important decisions, they should involve more, not fewer stakeholders. True collaboration makes for greater alignment, better decisions and better execution. “Executives don’t have to give up their power to …
The Next Generation of PBMs: New Technology, Simpler Business …
WEBAug 10, 2020 · New PBM entrants have emerged to bring new technology, a simpler business model, and more transparency. I propose to lay out a road map of where we are today and a guide to the market dynamics in the making. PBM background. The PBM industry began in the 1990s to meet the needs of the employer-based health benefit market.
How Precision Medicine and Genetic Testing Will Drive Value …
WEBNov 23, 2021 · Fortunately, huge gains are being made in the areas of genetic testing and precision medicine, which allow clinicians to use a patient’s genetic makeup and other molecular data in the course of providing care. VBC is especially promising in helping providers treat patients with chronic diseases. The …
Asembia’s Specialty Pharmacy Summit - Managed Healthcare …
WEBMay 3rd 2023. Adam Fein, Ph.D., talked about some surprising trends in specialty pharmacy and healthcare at the 2023 Asembia Specialty Pharmacy Summit. The number of specialty pharmacy locations may be peaking. And that "gross-to-net bubble" in drug prices that Fein has written about so much — well, it may be shrinking.
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