Making Sense of Cash Pay
Paying cash for healthcare services is not a new concept, but it’s also an option that is not widely used. The reason is because…
Resources
Adapt or Fall Behind: Making Nontraditional Plans Thrive
For nontraditional health plans to work — whether they use reference-based pricing or another strategy — they often require customized solutions. As health plans…
Direct Contracts & Healthcare Pricing Complexities – Part 2
Whether you’re using a reference-based pricing strategy or some other alternative, there are many challenges in creating an effective direct contract. Much of…
Direct Contracts & Healthcare Pricing Complexities – Part 1
Provider access is the biggest hurdle to successfully implementing a non-traditional health plan. Whether you are utilizing a reference-based pricing strategy or another alternative, direct…
Claim Denials: Their Rippling Effect on Health Plans
Claim denials are a complex piece of the healthcare system, and they can cause frustration for patients and providers alike. There are many…
Balance Bill Protection: Often Promised, Rarely Executed
A strong balance bill defense is essential to a successful reference-based pricing health plan. But what does that look like? And…
PBMs: Are You Getting Good Advice – Part 2
In the second half of our discussion on PBMs, Marc A. Sweeney, Pharm.D., BCMAS, Trevor Daer and Mike Kroupa return to give…
PBMs: Are You Getting Good Advice? – Part 1
Unbundling health plans can be rewarding for both employers and their employees, but it’s no secret that it comes with a unique set of…
RBP From the Front Lines: When the ‘Easy’ Plan Isn’t Member-Friendly
BUCAs may seem like the easy, all-inclusive choice, but they don’t offer the personal, one-on-one assistance most health plan members actually prefer. Plus, no…