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In the News: Mar 19–26

CMS Rolls Out Payment Model to Lower Insulin Costs

A recent Healthcare Dive article highlights CMS’s new voluntary initiative to lower the cost of insulin for those reliant on the drug. The program will lower the out-of-pocket costs for eligible diabetics who participate in Medicare Part D through a $35 cap to copays. With the help of pharmaceutical companies financing the coverage gap, CMS anticipates it can save $250 million over the span of 5 years.

Today, insulin copays fluctuate month by month, which can cause financial unbalance as well incentivize patients to ration the drug. The new model looks to stabilize copays for a variety of insulins, which will allow consumers to financially plan for their medical costs, and specifically targets individuals participating in higher-cost Part D plans, known as enhanced plans. Approximately 25 million beneficiaries participate in these plans, and individuals can expect to save $446 a year on average in out-of-pocket insulin costs.

Provider organizations must adapt to the dynamic changes of diabetes care management to care for a high-utilizing patient population. Constructing a comprehensive program that addresses patients susceptible to comorbidities and other chronic diseases is vital to health systems shifting toward value-based care. To learn more about developing a comprehensive diabetes program for your patients and surrounding communities, please read the Sg2 FAQ Comprehensive Diabetes Care.


Revenue Cycle Start-Up Tackles Price Transparency

A recent MobiHealthNews article discusses tech start-up companies’ efforts to simplify patient billing and reimbursement. Salt Lake City–based start-up, Rivet Health, offers health care revenue cycle management software to estimate and collect patient costs up front, understand payer rates and detect underpaid claims.

According to the article, 30% to 60% of patient revenue is lost because health systems are not able to collect on debt. Rivet Health’s new platform provides patients a price estimate prior to their services, as well as the option to pay beforehand or shortly after receiving care. The cloud-based platform also gives providers better insight into billing processes to ensure they are being compensated appropriately for their services.

Savvy health care consumers are increasingly making trade-offs as they shop for services. Quality, price, access and convenience are high on their lists. In response, many systems are recalibrating their offerings—through expanded channels, digital outreach and wellness-oriented products—to meet consumers on their own terms. To learn more about fixes aimed at common consumer pain points around access, convenience, transitions and billing, please review the Sg2 report Reinventing the Patient Journey: A Consumerism Update and Outlook.


Changing Demographics Spur Age-Friendly Care

Recently Second Wave Michigan featured efforts by Michigan’s providers and health systems to adopt age-friendly care models. Research shows the state will be the first where residents aged 65 and older outnumber residents aged 18 and under. Michigan’s shifting demographics show the need for health care providers to reevaluate and modify how they provide care.

The state has adopted innovative strategies, including building geriatric EDs and altering clinical practice, to meet to the physical limitations of many seniors. They have also adopted the 4 “M”s, a set of evidence-based practices that aligns with the desires of older adults and their families across the System of CARE.

Understanding how to best integrate senior-friendly care services is an essential component to the continuum of care. Even as an increasing number of health systems strive to provide age-friendly care, many struggle to define and execute on the delivery of an appropriate cadre of senior services. To learn more about how to best integrate essential senior services into your System of CARE, please review the Sg2 FAQ Silver Tsunami: A Coordinated Response to an Aging American Population.

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