The Importance of IBNR in Self-Funded and Traditional Health Plans
Understanding and accurately predicting future liabilities is crucial to the sustainability and success of insurance companies and self-insured employer-sponsored health plans...
Inflation Reduction Act Pharmacy Provisions – Implications and Other Changes
This is the final article in a three-part series[1],[2] discussing the impact of the Inflation Reduction Act (IRA; H.R. 5376)[3] provisions. First, we’ll cover the Medicare...
Inflation Reduction Act Pharmacy Provisions – Part D Changes
This is the second[1] in a three-part series discussing the impact of the Inflation Reduction Act (IRA; H.R. 5376)[2]provisions. Here we’ll look deeper into the changes coming to Medicare...
Diagnosis Co-Occurrence
Patients with multiple chronic diseases constitute a small minority of the total population but the majority of healthcare costs. These patient’s healthcare needs cannot be understood...
Understanding Provider Financial Losses in Value-Based Contracts
The shift from fee-for-service (FFS) healthcare models to value-based care (VBC) has been a monumental transformation in the healthcare industry. However, as this transition unfolds, it has added significant complexity to the healthcare system...
Drug Price Negotiation Program
This is a follow-up to a prior Inspire Blog article[1] we posted and the first of three we’ll be posting now that more information, detail, and realities have come to pass; this post delves deeper...
Differentiating Virtual Education to Optimize Outcomes
Prehospital medicine/patient care is a newer profession still being defined and, in many ways, redefining its role in today’s healthcare system. Prehospital medical/EMS education is...
What is the “Value” in Value-Based Care?
In the ever-evolving landscape of healthcare, the terms "value-based reimbursement" and "value-based care" (VBC) have become buzzwords that signify a shift in how we approach...
Absence of Variation in Health Care
As we try to identify key causes of high US healthcare costs, the topic of variation, specifically variation in practice style, often emerges. It is an accepted fact that in manufacturing quality...
Plan Design Considerations for Self-Funded Employers
Unlike insurers whose plans must comply with strict metal tier and essential health benefit requirements, self-funded groups benefit from flexibility of plan design and offerings. However...