Sep 22, 2023 | Managed Care Friday
56%: Cataract surgery costs this much more when performed in a hospital outpatient department compared to an ASC. This is according to data from the BCBS Association. Analysis was performed on claims data for six common outpatient procedures across 133 million BCBS members from 2017 to 2022, which showed costs are consistently higher when procedures are performed in the hospital versus a lower site of care. Differences ranged between 31% more for clinical visits in the HOPD to 58% more for diagnostic colonoscopies. Closing The Gap: A new incentive program BCBS of NC started this year focuses...
Sep 15, 2023 | Managed Care Friday
5.4: The amount employers expect health benefit costs per employee to rise in 2024, largely due to market wide factors like inflation and labor shortages, along with healthcare specific costs like the approval of more gene and cellular therapies and increased utilization of the GLP-1 drugs for weight loss. This projected increase is larger than what employers have seen year over year in the past, which means self-insured employers will likely put additional pressure on health plans to try to keep costs down. “Expect continued emphasis on preventive measures, using telehealth to guide...
Sep 8, 2023 | Managed Care Friday
77: The percentage of mental health students and young practitioners ages 20-30 we polled who are both working toward a license as a therapist, psychologist or psychiatrist and would prefer to have or join a virtual practice. Injection At The Rx Counter: Bicycle Health, a telehealth provider of opioid use disorder treatment, is partnering with Albertsons to make prescriptions for Sublocade available at Albertsons pharmacies, which also include Safeway and Acme. The injection can be administered monthly as an alternative to taking a daily oral version. Once Bicycle Health patients receive a...
Sep 1, 2023 | Managed Care Friday
53%: The increase in spend on mental health services between March 2020 and August 2022, according to a new study in JAMA Health Forum. The study from the Rand Corporation and Castlight Health analyzed claims from about 7 million privately insured adults who are covered through workplace health plans, which means this number may not accurately reflect the true demand for these services. Those with government-sponsored plans and with coverage through the exchanges likely also saw an increase in mental health spend over the past few years. 5 Pillars: Severe mental illness and substance use...
Aug 25, 2023 | Managed Care Friday
3.5: Percent of middle-class Americans with medical debt, more than any other class, according to a KFF estimate. Experts think this is because middle-income Americans, who earn $50,000-$100,000 a year, are more likely than those with lower incomes to seek care but they don't qualify for Medicaid or charity care to help pay for it and often fall into the gap between affordable ACA plans and Medicaid. Those with higher incomes, and typically better insurance coverage, have the least amount of medical debt unsurprisingly. Wait For It: Unranked in 2023, the #1 payer priority heading into 2024...
Aug 18, 2023 | Managed Care Friday
66: Percent of adults in the US who have a personal or familial experience with alcohol or drug addiction, according to a new KFF poll, highlighting how substance use disorders affect not only individuals but also their friends and family. 27% of adults who have a relative with an addiction report that their mental health was significantly affected by it, but only 46% got treatment. Bye Bye Pre Approval? United Healthcare will begin a two-phased approach to eliminating some prior authorization requirements in September. This will occur across commercial, MA and Medicaid plans and most...
