Unlocking Transparency in PBM Pricing
Dan Reedy, senior director of pricing and underwriting for Abarca, spoke recently with MedCity News about what payers should consider as they explore new models and press for greater transparency.
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Elation Health’s New Integration Brings Drug Pricing Transparency to the Point of Care for PCPs
Elation Health integrated Surescripts’ real-time prescription benefit tool — which gives clinicians immediate access to patient-specific medication coverage and cost data — into its EHR. The partnership aims to improve patients' medication adherence by helping primary care physicians have more meaningful conversations with their patients about prescription affordability during visits.
The Impact Brands: Empowering Wellness Through Natural and Holistic Solutions
In an era of escalating healthcare costs and a growing preference for natural, holistic approaches to health, The Impact Brands emerges as a collective of diverse brands dedicated to supporting overall wellness through natural means.
Despite Price Transparency Laws, Americans Are Nowhere Near Able to Shop for Care. How Can This Change?
Most hospitals and payers have publicly posted their pricing information, but experts think that data will remain mostly useless for consumers for at least another five years. Now that the data is available, healthcare software companies must step in and build tools that are personalized and easy to use. That way, consumers can eventually use price transparency data to shop for care.
2024: A Pivotal Year in Curbing Pharmacy Costs
2024 stands at a critical juncture in the battle against soaring pharmacy costs. In 2023, prescription drug costs rose by 8.4%, a 31% increase from the prior year. Stopping this cost escalation requires restructuring the role of pharmacy benefit managers (PBMs) from multiple fronts. On one front, Congress must pass the proposed legislative reforms that […]
Turquoise Health Raises $30M for its Price Transparency Software
Turquoise Health closed a $30 million Series B round, which brings its total funding to date to $55 million. The San Diego-based startup, which has more than 160 customers, sells a platform that makes it easier for hospitals and payers to comply with price transparency regulations.
What Was the Most-Repeated Word in CVS Health CEO’s JPM Presentation?
The word has gained greater urgency in recent years as the consumer trend in healthcare has forced payers, providers and all other kinds of healthcare stakeholders to swear by it.
Using Informed Awareness to Transform Care Coordination and Improve the Clinical and Patient Experience
This eBook, in collaboration with Care Logistics, details how hospitals and health systems can facilitate more effective decision-making by operationalizing elevated awareness.
Hospitals Finally Reached Widespread Price Transparency Compliance in 2023
Hospitals markedly improved their compliance with price transparency regulations in 2023, according to a new report. It found that more than 90% of hospitals have posted a machine-readable file containing gross charges, negotiated charges and cash prices for the services and items they provide.
The Transparency in Coverage Rule Doesn’t Go Far Enough: How to Make the Mandate Meaningful
The mandates set the framework and data requirements for transparency but consumers need more guidance for informed decision-making and comparisons. Health plans should be acting now to turn the conversation from compliance to true member engagement.
Americans’ Healthcare Costs Are Rising With the Pace of Inflation, Report Says
During the first three quarters of 2023, the prices for CMS’ 500 shoppable services increased by 2.0%, according to a new report. This figure is in alignment with the 1.9% U.S. inflation measured by the Personal Consumption Expenditures Price Index and below the overall U.S. inflation rate measured by the Consumer Price Index.
Bipartisan Price Transparency Bill Passes in House
The Lower Costs, More Transparency Act has passed in the House with bipartisan support. The action is being applauded from several advocacy organizations.
At ViVE 2024, Panelists Share Prior Authorization Progress and Frustration in Payer Insights Program
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Zocdoc CEO Predicts 5 Ways Patient Behavior Will Change in 2024
Zocdoc Founder and CEO Oliver Kharraz gave five predictions about how patient preferences will evolve in 2024. Some of them include Americans increasingly seeking cash-pay care options and an uptick in patients seeking mental health appointments before and after the presidential election.
Meaningful Hospital Price Transparency Requires Actual Prices, Not Estimates
Only actual hospital prices, displayed as dollars and cents, not estimates, formulas, or algorithms, protect patients from outrageous bills and hold hospitals accountable for overcharges, errors, and fraud. Accepting CMS' or other substitutes instead of actual prices undermines broader efforts to make hospital price transparency a reality for American patients and healthcare consumers.
Hospitals’ Price Transparency Compliance Is Improving Despite Remaining Low at 36%
About 36% of U.S. hospitals are in compliance with CMS' price transparency rule, up from 24.5% in February, according to a new report. This progress will remain slow unless CMS can do a better job of effectively enforcing its rule, the report declared.
Ticking the Talons of Healthcare Transparency
As of January 1, employer-sponsored Group Health Plans and Health Insurance Issuers must make make the prices of 500 medical services available via an Internet-based tool. The Transparency in Coverage final rule gets even tougher on January 1, 2024, when the prices of all medical services must be made available via an Internet-based tool.
Top 10 Hidden Facts About Hospital Prices
Here are the top 10 hidden facts about hospital prices that answer questions about why it is so expensive and why the bills are so complicated.