On February 10, 2022 price inflation jumped by 7.5% over the past 12 months, its highest annual increase in 40 years. For employers and other health care purchasers that monitor their claims cost and utilization data religiously (who doesn’t?), this news prompts questions from purchasers about how inflation will impact their future health care spend.
Getting these details right will determine if implementation of the No Surprises Act will not only protect patients from most high and unexpected medical costs but also help reduce the need for balance billing in the first place and keep prices in check.
Back in October 2019, we published a blog post on the challenges of building a high-performance network (HPN). We landed on the conclusion that an HPN should be designed with sensitivity to
Suzanne Delbanco catches up with CJ Stimson, MD, JD, the Senior Vice President of Value Transformation at Vanderbilt University Medical Center (VUMC), to discuss Vanderbilt’s direct contract bundled payment arrangement for maternity care with Metro Nashville Public Schools (MNPS).
Employers and consumers are eager for solutions that attack health care cost inflation at its root cause. One prominent strategy is using reference-based pricing (RBP) models that anchor commercial rates to Medicare, or some other rationalized external benchmark. Like so many health care innovations, reference-based frameworks encompass multiple branching models, and as such the term “RBP” has come to mean different things to different stakeholders.
Would 2020 be the year that health care purchasers finally abandon broad PPO networks in favor of curated solutions like narrow, tiered or high-performance networks? Julianne McGarry review’s KFF’s 2020 Employer Health Benefits Survey to find out.
Unpacking the complexity of high-performance network design The National Business Group on Health (NBGH) predicted that by 2018 a staggering 61% of employers would offer narrow or high-performance networks (HPNs).
Last week, we told you about a $4,999 surprise bill. I didn’t have a $4,999 surprise, but it was close. At 30 years old, I had a tonsillectomy. I was
What happens when a patient goes to the emergency room and gets treated by a doctor that’s out of network – even if the hospital facility is in-network? Or if
