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In the News: October 25–November 1

Virtual Health Coverage Grows in Private Insurance Plans

A recent research article published by Health Affairs analyzed findings from the 2018 Henry J. Kaiser Family Foundation Employer Health Benefits Survey. The survey, completed by 2,160 employers from the private and nonfederal government sectors, gathered data on health insurance premium and deductible costs and on trends in private insurance coverage.

With the cost of care continually increasing, as borne out by the survey results—for example, the average deductible for single coverage was about $1,573 in 2018 compared to roughly $735 in 2008—more workers are looking for higher-value options for care, such as retail clinics and virtual health. And these services are increasingly being covered by insurers. According to the survey, virtual health coverage increased 10% between 2017 and 2018.

Virtual health coverage is growing across the country as payers recognize its benefit to consumers. For recent trends related to the virtual health legislative and payment landscape, register for the upcoming webinar Virtual Health Update 2018: Legislation and Payment.


Physician Aversion to APMs Due to Drug Cost Concerns

A recent Modern Healthcare article shared the results of a study conducted by the American Medical Association (AMA) and RAND Corporation regarding physicians’ perspectives on alternative payment models (APMs) where physicians take on downside risk. The study found that doctors resist taking on risk in APMs, whether federal or private-pay models, because they do not want to be responsible for increased patient spending on high-priced drugs. Physicians reported that they felt APMs have yet to balance the risks and rewards appropriately, with savings targets that do not keep pace with the high cost of drugs.

Sg2 believes that physician leadership is an essential component for health systems to succeed in risk-based payment models. With recent federal policy proposals focusing on increasing opportunities for physicians to become more engaged in APMs, health systems need to recognize the strategic imperative of partnering with physicians in their market. To learn more about the movement toward value-based care, read the Sg2 Expert Insight Value-Based Care: Are We There Yet?


AMA’s Updated Tool Helps Map Medically Underserved Areas

The American Medical Association recently released an enhanced version of its Health Workforce Mapper, a mapping tool designed to flag medically underserved areas and identify social determinants of health (SDH) affecting the well-being of patients. Population health data have been added to the tool, allowing providers to track factors such as smoking and obesity rates by geographic location.

The tool also allows users to view relationships between seemingly unrelated indicators, such as an area’s air pollution level and uninsured rate.The enhanced mapper will help practices better understand patient access needs and demands for service across communities. The AMA also hopes the tool will assist policy makers by providing evidence to aid decision making in alignment with workforce distribution.

New data and research continue to highlight the staggering effect of social determinants on health. With the US healthcare landscape evolving to focus on managing the health of individuals and value-based care, it’s essential for organizations to think beyond the traditional care setting. To learn how safety net providers have addressed SDH, read the Sg2 Expert Insight Improving the SDH System of CARE: Lessons From Safety Net Providers.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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