Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.

Pharmaceutical industry observers say CVS Health’s creation of Cordavis, a new biosimilar drugs company, is part of a strategy to make its move into this market as profitable as possible.

The CEO of Providence Health Plan visits the Payer’s Place and addresses the future of payment models.

Amgen and the Federal Trade Commission are settling the lawsuit the regulator filed to block the pharmaceutical giant’s $28 billion Horizon Therapeutics acquisition. As part of the settlement, Amgen agrees not to “bundle” its products with Horizon’s drugs in negotiations with health plans.

Carrie Kincaid, Senior Vice President, Market Development at Priority Health discusses how Priority Health is addressing the gaps in rural healthcare.

Peter Long of Blue Shield of California discusses how they focus on member experience and ways to improve their overall healthcare needs.

We need a streamlined approach where stakeholders can perform all critical tasks — from enrollment and patient consent to prior authorization, from real-time benefit checks to financial assistance — on a central platform powered by a business rules engine, automated workflows, and real-time analytics.

OptumRx’s Chief Clinical Officer shares his insights on the latest developments and trends he’s seen in the healthcare industry.

Pear Therapeutics was once regarded as a digital therapeutics pioneer, but its spiral into bankruptcy has the industry searching for the best path forward. While some favor going direct to consumers, others say the solution is in generating more robust clinical trial data to persuade hesitant payers.

The series, part of a content partnership between HLTH and MedCity News, will share insights from executives from both public and private payer organizations based on developments and trends they’ve seen in the healthcare industry and what keeps them up at night.

Medicare will cover Alzheimer’s disease drugs granted traditional FDA approval, CMS announced. But the decision keeps the spirit of an earlier coverage determination, which called for the gathering of more evidence about the safety and efficacy of these therapies.

A panel during the MedCity News INVEST conference discussed what digital health technologies need to do to demonstrate return on investment for payers, providers, and other stakeholders.

A panel discussion at the annual Abarca Forward conference in Puerto Rico last month sought to identify some of the innovative financial approaches that can be applied to managing the high price of novel therapies. Conversations also addressed what payers need for these financing models to be sustainable.

Pear Therapeutics’ Chapter 11 bankruptcy filing follows three corporate restructurings and the inability to secure additional financing to support commercialization of its FDA-cleared prescription digital therapeutics. An auction of Pear’s assets is expected to happen in early May.

CMS put out a request for information in October about a CMS-led national provider directory that would allow patients to find and compare providers based on preferences like language and location. Alexandra Mugge, director and deputy chief health informatics officer of the Health Informatics and Interoperability Group at CMS, said there is stakeholder support for the national directory — if it’s executed correctly.

Companies who raised drug prices higher than the rate of inflation must rebate the difference to Medicare, according to a provision of the Inflation Reduction Act. The highest-profile product on the list might be AbbVie’s blockbuster immunology drug Humira.

A webinar sponsored by Intelligent Medical Objects April 11 will explore how payers are meeting the needs of the 2016 21st Century Cures Act when it comes to providing unfettered access to structured medical data for members.

Payers and providers face different challenges when it comes to compliance. The volume of price transparency data that hospitals must disclose online amounts to about 3 terabytes — compared to the whopping 630 terabytes of data that payers have been tasked with posting.

More than half, or 58%, of health plan members are “overwhelmed” when it comes to managing their health plans. Insurers need to provide information in a way that’s accessible and easy to understand, the report stated.

Moving to value-based care models isn’t easy. But payers may be in the best position to make this change, according to the Business Group on Health. Employers, meanwhile, can encourage their employees to receive care from providers participating in value-based care.

When asked what their biggest difficulties are today, 46% of payer leaders said managing costs and 41% said driving operational efficiencies. The reason for this could be increasing claims volumes from the Covid-19 pandemic, rising costs from people delaying care and the use of outdated systems, the survey said.

Tomorrow Health — a platform that makes it easier for patients, providers and payers to coordinate home-based care — closed a $60 million Series B funding round on Tuesday, bringing its total funding to date to $92.5 million. The startup will use the funds to expand its partnerships with payers, grow in new markets and further develop its technology.

Even though payers and providers still struggle to effectively collaborate, health tech vendors can often act as a linking agent to improve outcomes for both sides.

Pulling back the curtain on healthcare pricing is easier said than done, acknowledged Chris Severn, the company’s co-founder and CEO. That’s exactly why the investment is so important.

Dental payers can no longer rely on the processes, methodologies and technologies of the past. They must adopt new technologies, like automation, that deliver the level of performance required to compete in today’s digital world.

Check out new developments from Seven Bridges, Healthmine, Bright Health, and My One Medical Source.

Value-based healthcare puts the focus on patient outcomes, but payers have a part to play as well. A panel at MedCity News’ INVEST conference discussed how reimbursement strategies can improve patient care and reduce costs.

The Center for Medicare and Medicaid Services proposes covering Biogen Alzheimer’s disease drug Aduhelm only for people enrolled in a clinical trial. In explaining this proposal, the agency cited the unclear benefit to patients as well as the documented safety risks associated with the drug, which can be best monitored within the context of a clinical trial.

The price of Biogen Alzheimer’s disease drug Aduhelm will be cut in half at the start of 2022, a move that comes as a Medicare recommendation on coverage is expected early next year. Meanwhile, Biogen is preparing corporate measures projected to save $500 million annually, cost-cutting made necessary in part due to slow market uptake of Aduhelm.

According to a recent survey, 59% of hospital finance leaders are looking to advance into Medicare Advantage models next year. They still face obstacles in switching to risk-based models, including striking partnerships with payers and having the needed technical capabilities.