Earlier this month, AHIP hosted its 2024 conference, gathering health insurers, providers, and other healthcare professionals, to discuss pivotal industry issues. Alessa Quane, Chief Insurance Officer at Oscar, participated in the conference to offer insights into the ACA’s rapid expansion, evolving consumer expectations around affordability in healthcare, and the opportunities within the ICHRA market. Lauren Berryman at Modern Healthcare reports on her top takeaways from the conference, sharing key highlights from Alessa’s panel, “Oscar Health [...] nevertheless [sees] opportunities in the individual market via employer-sponsored individual coverage health reimbursement arrangements, or ICHRAs,” she writes. Read the full event recap here: https://lnkd.in/ed4NpknU
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Key points from Discovery Health CEO Ron Whelan on President Ramaphosa’s signing of the NHI Bill - President Ramaphosa to sign National Health Insurance (NHI) Bill. - Discovery Health CEO Ron Whelan expresses disappointment due to flaws in the bill. - Discovery Health supports universal health coverage but deems current NHI Bill unconstitutional and unfeasible. - No immediate impact on medical schemes expected; status quo remains for now. - Implementation of NHI projected to take several years, possibly decades. - Funding remains a critical barrier to NHI's viability. - Discovery Health advocates for private sector collaboration in healthcare. - Flaws in the NHI Bill and legislative processes may lead to legal challenges and delays. - Discovery Health pledges to engage constructively while defending rights of medical scheme members. - Commitment to supporting healthcare partners, investing in both public and private healthcare systems.
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Aligned, hybrid primary care payment models that combine capitation alongside some fee-for-service payments are gaining traction in California. However, some key decision-makers have questioned the feasibility of adopting capitation as a payment mechanism among self-funded and flex-funded health coverage arrangements. A new issue brief from IHA and the Purchaser Business Group on Health (PBGH) 's California Quality Collaborative explores how regulatory oversight of health coverage affects opportunities for hybrid primary care payment in self-funded health insurance arrangements in California. The brief examines several topics, including: ✔️Primary care payment alignment and the role of capitation ✔️Regulatory context related to primary care payment in California ✔️Primary care capitation in self-insured plans: allowable conditions, remaining uncertainty Access the full brief here: https://hubs.li/Q02yr2770
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🤦I have experienced the woes of the prior authorization process both as a consumer and obviously seen the struggles of surgeons on the industry side! 🗻It’s clear that everyone (both consumer and healthcare professionals) are becoming more aware of what health insurance payers/carriers are doing. There are clear mountainous barriers to care for many unfortunately; and thankfully people are starting to fight for change. 💪I am happy that my home state has taken such a major step to changing the prior authorization landscape as I personally know how difficult and time consuming it can be, just to receive necessary healthcare. (2026 can’t come fast enough…) 📜I hope more legislation follow suit and makes more change for the better! 🤔What else can we influence change on to make this system better? Article in the comments below! #medicine #hospitals #healthcare #medicaldevices #spinesurgery #minimallyinvasive
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Regulatory & Litigation attorney helping physicians, researchers and businesses manage risks | Psychedelics & Emerging Therapies co-lead | 2023 Emerging Therapies, Life Sciences Trailblazer | Avid flower gardener 🌻
📢 Our latest article, "3 Health Insurance Paths For Psychedelic-Assisted Therapy," co-authored by Kimberly Chew, Jameson Sauseda, and Noreen Vergara, has just been published on Law360! 🌈 Against the backdrop of evolving societal perceptions and regulatory frameworks, we delve into the promising future of psychedelics as a breakthrough solution for complex mental health conditions. 💡 Discover how recent scientific advancements, including FDA breakthrough designations and legislative initiatives, are paving the way for the integration of psychedelic therapies into mainstream healthcare systems. 🚀 We dissect three key pathways for achieving health plan coverage, from state insurance mandates to navigating the regulatory landscape post-FDA approval and DEA rescheduling #psychedelics #healthinsurance #mentalhealth #ketamine
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I'm sure you think that your group health insurance premiums are already too high. They're going up again next year. Here's a quote from a study from Price Waterhouse Coopers: "Commercial healthcare costs will increase by a projected 8% in 2025, driven by inflationary pressure, prescription drug spending and behavioral health utilization, according to a report from the PwC Health Research Institute." You may find that you can save 15-25% by switching to a plan that has Reference Based Pricing (RBP). We can help
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Orthopedic surgeon | Pioneer of insurance free and mobile orthopedic care | Antagonist of health insurance and large hospital conglomerates | Founder and CEO of Easy Orthopedics
So how do we fix our healthcare system? We don't. Leave it alone, there is no fixing it. We are better off just starting a new system, and many of us have been doing that. Here is the main problem with fixing it: right now health insurance companies and their subsidiaries, pharmaceutical company, and large hospital systems are making money hand over fist. So much money that it would give you a giant headache. They like our healthcare system, because even though are providing substandard care while bankrupting people and employers, those above mentioned entities are doing very well. They care about the bottom line and not much else. They also have very well funded lobbying groups. Good luck competing with that. So the solution is not to try and "fix" the system. It's just to create a system that relies on pharmaceutical companies, health insurance, and hospital systems as little as possible. Where both the physician and patient avoid them to the best of their ability. It is called direct care, and it is already happening. Slowly but surely it is happening. #healthcare #healthinsurance #Medicine #directcare
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UPCOMING DEADLINE! Group health plans and health insurance issuers must annually submit detailed information on prescription drug and health care spending to the federal government. This reporting is referred to as the “prescription drug data collection” (or “RxDC report”). The next RxDC report is due by Saturday, June 1, 2024, covering data for 2023. Employers should confirm they are taking steps to comply with this reporting deadline, such as providing information to third-party vendors on a timely basis. Here is a list of steps employers must take and other important information: https://lnkd.in/eVnX53yP #bolton #health #healthcare #healthplans #deadline #rxdc #employeebenefits #prescriptiondrugs
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Health care costs are rising. When providers significantly charge more for specialty drugs, that impacts people and families across the country. In fact, a recent AHIP study found that provider markups on specialty drugs increased commercial health insurance premiums by $13.1 billion in 2024 alone. To address this issue, we need to promote transparency in drug pricing and reimbursement and encourage price competition among providers and specialty pharmacies. It's time for us to come together and make health care more accessible for all Americans. https://lnkd.in/e6UE3Fjn #Health #HealthCare #HealthCareOnLinkedIn #Affordability
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Delighted to moderate a discussion among a distinguished panel comprising healthcare private insurance stakeholders, medical device companies and health services providers association on frameworks to include new medical products within the ambit of private insurance. While public health insurance schemes such as AB-PMJAY play a pivotal role in extending financial protection to marginalized populations, the private health insurance sector serves as a complementary pillar, catering to the growing aspirations for quality healthcare services among the urban middle class and affluent segments of society. With the increasing incidence of non-communicable diseases, escalating healthcare costs, and evolving consumer preferences, private health insurers are confronted with the imperative to innovate and adapt their product offerings to meet the evolving needs of policyholders and patients. The discussion threw light on the pathways for inclusion of innovative medical devices and home healthcare services within health insurance framework. #EVERSANA was the knowledge partner with #APACMed for this event. Dr. Mahendra Kumar Rai, Ram Prasanna and myself worked closely with Adip Puri and Ankit Sharma on this initiative. https://lnkd.in/dzPpEvtD
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The Bismarck Healthcare System uses in other Democratic capitalistic societies doesn’t remove profits from healthcare, it profit neutralizes only the health insurers making them utilities instead of luxuries enabling access to quality affordable private insured and private manufactured FFS healthcare with better access, outcomes, costs and more hospitals and insurers competing capitalistically per capita than America’s segregated syndicated healthcare system. #tripleaim Read about it here : Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition - The Lancet https://lnkd.in/ecUwsHWP
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