Oscar Health’s Post

🤦I have experienced the woes of the prior authorization process both as a consumer and obviously seen the struggles of surgeons on the industry side! 🗻It’s clear that everyone (both consumer and healthcare professionals) are becoming more aware of what health insurance payers/carriers are doing. There are clear mountainous barriers to care for many unfortunately; and thankfully people are starting to fight for change. 💪I am happy that my home state has taken such a major step to changing the prior authorization landscape as I personally know how difficult and time consuming it can be, just to receive necessary healthcare. (2026 can’t come fast enough…) 📜I hope more legislation follow suit and makes more change for the better! 🤔What else can we influence change on to make this system better? Article in the comments below! #medicine #hospitals #healthcare #medicaldevices #spinesurgery #minimallyinvasive

Key points from Discovery Health CEO Ron Whelan on President Ramaphosa’s signing of the NHI Bill - President Ramaphosa to sign National Health Insurance (NHI) Bill. - Discovery Health CEO Ron Whelan expresses disappointment due to flaws in the bill. - Discovery Health supports universal health coverage but deems current NHI Bill unconstitutional and unfeasible. - No immediate impact on medical schemes expected; status quo remains for now. - Implementation of NHI projected to take several years, possibly decades. - Funding remains a critical barrier to NHI's viability. - Discovery Health advocates for private sector collaboration in healthcare. - Flaws in the NHI Bill and legislative processes may lead to legal challenges and delays. - Discovery Health pledges to engage constructively while defending rights of medical scheme members. - Commitment to supporting healthcare partners, investing in both public and private healthcare systems.

Aligned, hybrid primary care payment models that combine capitation alongside some fee-for-service payments are gaining traction in California. However, some key decision-makers have questioned the feasibility of adopting capitation as a payment mechanism among self-funded and flex-funded health coverage arrangements. A new issue brief from IHA and the Purchaser Business Group on Health (PBGH) 's California Quality Collaborative explores how regulatory oversight of health coverage affects opportunities for hybrid primary care payment in self-funded health insurance arrangements in California. The brief examines several topics, including: ✔️Primary care payment alignment and the role of capitation ✔️Regulatory context related to primary care payment in California ✔️Primary care capitation in self-insured plans: allowable conditions, remaining uncertainty Access the full brief here: https://hubs.li/Q02yr2770

📢 Venteur's Official Statement on 2024 Medical Cost Trends As a leading health insurance benefits platform, Venteur is committed to staying ahead of the curve. In our latest statement, we dive into the projected medical cost trends for 2024 and what it means for businesses and individuals. The healthcare landscape is ever-evolving, and understanding the trends can help you make informed decisions when it comes to your benefits strategy. Our analysis explores factors such as rising prescription drug costs, technological advancements, and shifts in healthcare utilization. We believe that knowledge is power, and by keeping you informed about the latest industry trends, we empower you to navigate the complex world of healthcare with confidence. Visit the link below to read our position on the 2024 medical cost trends. #healthcaretrends #medicalcosts #wellness

UPCOMING DEADLINE! Group health plans and health insurance issuers must annually submit detailed information on prescription drug and health care spending to the federal government. This reporting is referred to as the “prescription drug data collection” (or “RxDC report”).    The next RxDC report is due by Saturday, June 1, 2024, covering data for 2023. Employers should confirm they are taking steps to comply with this reporting deadline, such as providing information to third-party vendors on a timely basis.    Here is a list of steps employers must take and other important information: https://lnkd.in/eVnX53yP #bolton #health #healthcare #healthplans #deadline #rxdc #employeebenefits #prescriptiondrugs

PODIATRY ALERT In the last issue of APMA News, a featured article advised us to pay attention to Value-Based Care (VBC) for our own benefit as well as the future benefit of our profession. This is great advice. Strict attention to provision of quality lower extremity health care has always been a very valuable practice asset. Now, as medical services are being hyper-scrutinized by health insurance payers, VBC is quickly becoming a practice growth necessity. The problem is that very few DPMs are paying much attention to the importance of VBC in this post-Covid-19 quickly changing health care marketplace. But those podiatrists who do understand the significance of this transition and are acting accordingly will certainly be rewarded.

There’s clearly little evidence that 50 years spent building horizontally and vertically integrated rationing, segregating and inequitably subsidized mega-profitable health insurance conglomerates has improved most Americans healthcare access, outcomes or costs. The answer is to simply employ the Bismarck HC Model successfully used by Germany, Switzerland, Japan, Netherlands and other democratic capitalistic nations to enable access for all citizens to quality affordable private insured and private manufactured and produced FFS medical care at a fraction of the cost of American healthcare with better clinical outcomes and costs (value). Read about it here https://lnkd.in/evX8nur

The Bismarck Healthcare System uses in other Democratic capitalistic societies doesn’t remove profits from healthcare, it profit neutralizes only the health insurers making them utilities instead of luxuries enabling access to quality affordable private insured and private manufactured FFS healthcare with better access, outcomes, costs and more hospitals and insurers competing capitalistically per capita than America’s segregated syndicated healthcare system. #tripleaim Read about it here : Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition - The Lancet https://lnkd.in/ecUwsHWP

Health care costs are rising. When providers significantly charge more for specialty drugs, that impacts people and families across the country. In fact, a recent AHIP study found that provider markups on specialty drugs increased commercial health insurance premiums by $13.1 billion in 2024 alone. To address this issue, we need to promote transparency in drug pricing and reimbursement and encourage price competition among providers and specialty pharmacies. It's time for us to come together and make health care more accessible for all Americans. https://lnkd.in/e6UE3Fjn #Health #HealthCare #HealthCareOnLinkedIn #Affordability

So how do we fix our healthcare system? We don't. Leave it alone, there is no fixing it. We are better off just starting a new system, and many of us have been doing that. Here is the main problem with fixing it: right now health insurance companies and their subsidiaries, pharmaceutical company, and large hospital systems are making money hand over fist. So much money that it would give you a giant headache. They like our healthcare system, because even though are providing substandard care while bankrupting people and employers, those above mentioned entities are doing very well. They care about the bottom line and not much else. They also have very well funded lobbying groups. Good luck competing with that. So the solution is not to try and "fix" the system. It's just to create a system that relies on pharmaceutical companies, health insurance, and hospital systems as little as possible. Where both the physician and patient avoid them to the best of their ability. It is called direct care, and it is already happening. Slowly but surely it is happening. #healthcare #healthinsurance #Medicine #directcare