Employers

A new study from the Healthcare Financial Management Association, Leavitt Partners, and McManis Consulting found that the penetration of value-based payment (VBP) models is not yet enough to generate cost savings and is also not affecting clinical quality outcomes at the market level.

The ability to have a plan that’s going to work and be large enough that it makes sense for those involved is a barrier for employers who want to pursue alternative payment models, said David Merrill, HR benefits manager, Volusia County, Florida, and John Robinson, CEBS, REBC, RHU, president and CEO, RobinsonBush.

Scaling back the Comprehensive Care for Joint Replacement model and canceling an expansion proposed under the Obama administration represents a shift in philosophy from mandatory to voluntary bundled payment models. But some say that commercial payers and employers will demand change no matter what CMS does.

The Gallup-Sharecare Wellbeing Index released its estimate of the cost of diabetes for employers on World Diabetes Day.

Brian Marcotte, president and CEO of the National Business Group on Health, offers recommendations for employers that are considering accountable care organizations (ACOs) and describes situations when an ACO is not a good fit.

Employers have started to focus on fulfilling opportunities to control costs and supplying more services to help employees understand their treatment options and the healthcare system as a whole, explained Brian Marcotte, president and CEO of the National Business Group on Health.

Having employers and accountable care organizations agree on expectations is necessary for better alignment of care offered, explained Brian Marcotte, president and CEO of the National Business Group on Health.

Employers understand what accountable care organizations are, but they need a better understanding of how they deliver value better than the market, explained Brian Marcotte, president and CEO of the National Business Group on Health

"Voluntary" is the key word in today's wellness programs, after EEOC rules were tested in court.

After great effort to resolve apparent conflicts between the ACA and older statutes, including the Americans with Disabilities Act, a repeal of the healthcare law may send regulators back to the drawing board.

Reimbursement is not an issue for basic cancer tests, but questions surround the payment and guidelines for more cutting-edge medical innovations, said Bruce Quinn, MD, PhD, a consultant at Foley Hoag. He added that the role of employers in health management is not changing as quickly as we may think.

Obesity is more than just a lifestyle disease. Ted Kyle, RPh, MBA, principal at ConscienHealth, explained that understanding its complexities as well as the behavioral and physical care it requires is essential in improving the health and productivity of employees.

At the Payer Exchange Summit V, sponsored by the Community Oncology Alliance (COA), 2 employer groups and a provider participated on a panel to provide practical insight into the extraordinary challenges and decisions faced by employers and employees with a cancer diagnosis.

Also, the share of employers funding wellness programs has passed the 50% mark, but not all employees use them.

More employers are requiring prior authorization and the use of select specialty pharmacies for high-cost drugs.

The Pregnancy Discrimination Act of 1978 prevents questions about status from being asked, and does not require a woman to disclose her pregnancy in an interview.

Incentives in employee wellness programs, especially penalties, can hurt morale and lead to legal action. But without incentives, there's no guarantee the employer will see healthcare savings and return on investment.

Employers and employees are seeing eye-to-eye when it comes to integrated health benefits. Not only do employees see how an integrated plan can improve quality of care and health, but employers see how it makes good business sense.

The accountable care organization, or ACO, can be a mechanism for employers to achieve healthcare savings, according to a just-published article in The American Journal of Accountable Care, the publication of The American Journal of Managed Care dedicated to healthcare reform.

Retail health insurance marketplaces, also known as exchanges, are on the cusp of dramatically changing the health insurance business, according to a new report from PwC's Health Research Institute.

Laurel Pickering, MPH, president & CEO of the Northeast Business Group on Health, explains that employers are transitioning employees into consumers with the help of "transparency tools" centered around price and quality.

Can a diabetic's likelihood of developing complications depend on picking the right doctor? A study suggests it can.

MedImpact, a leading pharmacy benefit manager, will contribute the "Drug Trends" column for AJPB.

The American Journal of Pharmacy Benefits (AJPB) and the Pharmacy Benefit Management Institute (PBMI) today unveiled a strategic partnership between the two organizations, which will provide professionals in the pharmacy benefit management industry with free access to both AJPB and its flagship publication, The American Journal of Managed Care (AJMC).