The Opportunity: Unlocking the Power of Pricing Data For nearly two years, the healthcare industry has been working toward transparency in coverage mandates. With the recent 2022 adoption of the Transparency in Coverage rule, machine-readable files (MRFs) containing pricing data are now publicly available. By harnessing this data and turning it into actionable insights, Plans can gain the insights they …
Ushering in a New Era of Healthcare Cost Transparency
Healthcare cost information will soon be accessible to everyone across the healthcare ecosystem. Finalized by the Departments of Health and Human Services, Labor, and the Treasury on November 12, 2020, the Transparency in Coverage rule puts healthcare price information in the hands of consumers, providers, and health plans to empower stakeholders with the information they need to make informed healthcare …
Informing Medical Device Strategies with Real-World Data
Real-world health data plays a significant role in guiding the strategies and innovations of medical device manufacturers. Whether they are looking to develop commercialization strategies, gain regulatory approval, or demonstrate the value of their products, these manufacturers can use real-world data (RWD) and real-world evidence (RWE) to inform product development and assess their products’ potential value. Ultimately, developing new medical …
COVID-19 Challenges Continue: How Plans Can Now Track the At-Home Test Benefit
As of January 15, 2022, U.S. insurance companies and health plans are required to cover eight free over-the-counter, at-home COVID-19 tests per covered member per month. As with so many other aspects of this pandemic, payers were forced to pivot and respond quickly. Now they must provide government-mandated coverage and track and forecast their finances to manage their businesses prudently. …
National Healthcare Benchmarks are Broadening Employer Groups’ Perspective on COVID-19
One of the biggest challenges employer groups have faced during COVID-19 is a lack of perspective on the overall cost and utilization of their employees’ COVID-19 testing and treatment. They have employee claims data – and maybe their health plan’s data to compare against – but they don’t know how they compare more broadly. In response, health plans have been …
In Their Quest for Health Equity, Some Insurers Emphasize Mothers and Babies
If we look back on 2020 as the year that thrust racial inequities into the national consciousness, 2021 may be the year we see the tide start to turn. We’re starting to see efforts to address health equity progress across the healthcare ecosystem. Anthem, the largest of the Blue Cross Blue Shield affiliates, announced in August the creation of a …
Whyzen™ Analytics’ Latest Release Provides Faster Pathways to Healthcare Intelligence
By Sonal Sheth, Senior Director, Product Manager, Whyzen Analytics, and Kelvin Evans, Sales Executive BHI’s enhanced Whyzen™ Analytics platform enables health plans, employers, and brokers to quickly find and act on trends, cost savings, and care improvement opportunities. New guided analytics pathways and a more intuitive interface allow this next-generation reporting and analytics solution to sort through vast healthcare data …
Artificial Intelligence Saves Payers Time, Money
BHI’s Roxanna Cross was recently interviewed by Managed Healthcare Executive® magazine on the topic of AI, machine learning, and health insurance. The premise was simple: AI can save health plans money while improving care delivery and outcomes. An excerpt follows: “At Blue Health Intelligence (BHI), which provides clinical data expertise for Blues plans around the United States, programmers attacked the …
From Coronavirus Pandemic to Mental Health Epidemic
How employers are handling the mental health challenges of employees in the wake of COVID-19 The public health response to the COVID-19 pandemic may have saved millions from dying of the SARS-CoV-2 pathogen. But, according to researchers, the lockdowns, social distancing, and masking also had a significant impact on people’s mental health. COVID-19 was particularly hard on young adults and …
Health Plans Required to Provide Price Comparison Tool by January 2022
At the end of 2020, Congress passed the Consolidated Appropriations Act (CAA) which includes a number of key provisions for health plans. Among them is the requirement that health plans offer a web-based price transparency tool that will communicate expected costs of various services provided in a health plan member’s service area. The tool must provide out-of-pocket costs for these …