EHR Intelligence has an interesting article about pay for performance reimbursement structures in health care. The article is based on an interview with Michael Dermer, Chief Incentive Officer at Welltok. According to Mr. Dermer
Every single health plan has some type of reward and incentive program. I would argue that if a health plan doesn’t have a significant health and wellness incentive program sometime during the year 2015, they won’t be able to compete. When somebody goes to buy health insurance on a state exchange, for example, it will be very hard for a health plan to win business if they don’t have a robust reward program.Health Data Management reports about the increasing success of CAQH's EFT and ERA enrollment program that allows providers to enroll in electronic payments with multiple payers at no cost, eliminating redundant paper forms and saving administrative time and costs.
It’s going to start to look just like your credit card, airline, and hotel loyalty programs. It’s really grown and evolved. The thing about incentives is that you don’t write the check until somebody does what you want them to do. So, as long as you align it to the right behaviors, it’s got almost a built-in return.
Aetna and Cigna were the original participating insurers during 2013. In January, HIPAA operating rules requiring payers to support EFT and ERA went into effect and multiple insurers have joined during the first six months of 2014. They include WellPoint and 14 affiliates: Unicare, Empire Blue Cross Blue Shield, and Anthem plans in Colorado, Connecticut, Indiana, Kentucky, Maine, Nevada, New Hampshire, Ohio, Virginia, California, Missouri and Wisconsin. Additional insurers now participating include Blue Cross Blue Shield of Georgia, BlueCross BlueShield of Tennessee, CDPHP, CareCentrix, MAPFRE and Midwest Health Plan. Other payers committed to join in coming months are Kaiser Permanente, Humana, Health Plan of San Mateo and First Community Health Plan.Bravo!
Last week, HHS sent its annual HIPAA Privacy and Security compliance reports to Congress. In calendar year 2012 over half of the 222 HIPAA unsecured protected health information breaches reported to HHS resulted from theft. 68% of the breaches were reported by health care providers. In contrast, 7% were reported by health plans. The HHS breach report from which the FEHBlog took these statistics is worth a glance.
The Drug Channels blog analyzes 2013 trend reports from the four largest PBMs (Express Scripts, CVS Caremark, Prime Therapeutics, and Catamaran) here.
Finally Kaiser Health News reports that Cambria Health Systems, a northwestern U.S. Blues organization, is revving up a "huge" palliative care program. "The company is going to start paying for things not typically reimbursed by other insurance companies including home health aides and advanced care planning counseling. One of the larger initiatives is training physicians and caregivers in how to have appropriate conversations about end-of-life care."