Industry News: Volume 2, Issue 13

Seven Essential Ingredients for Direct Contracting Success

By Laura Carabello

The Self Insurer—As forward-thinking self-insured employers and Plan Sponsors face yet another year of growing pressures to further reduce healthcare expenditures, they now recognize that direct contracting relationships with the provider community offer an optimal solution.

These arrangements present a unique opportunity to gain control over both the quality and the escalating cost of health care benefits, enabling companies to design benefit offerings that are custom-tailored to meet the specific needs of its employee population.

To view the original article in its entirety, click here.

AscellaHealth’s Hub Solutions for Life Sciences Ensures Specialty Product Access and Market Entry, Optimizes Outcomes for Rare Disease Patients

BERWYN, Pa.–(BUSINESS WIRE)–AscellaHealth, a global healthcare and specialty pharmacy solutions company, announces its innovative life sciences solutions which address the challenges and barriers to accessing care and obtaining optimal outcomes that are facing rare disease patients – from burdensome social and financial difficulties, which may impede a timely start to therapy, to compliance issues relating to patients being able to stay on therapy. AscellaHealth’s unique solutions ensure that specialty products are successfully brought to market, while optimizing outcomes and the patient experience with a full spectrum of cutting-edge programs and services.

“Individuals with a rare disease or complex condition require a high level of support to ensure therapy adherence, as well as targeted programs and services that deliver specialized expertise that goes well beyond the traditional care continuum provided by legacy organizations that are simply built for scale,” says Dea Belazi, president and CEO, AscellaHealth. “AscellaHealth’s patient-first approach and high-level care coordination, highlight capabilities to strengthen communication and produce rich data for more informed decision-making that improves overall patient engagement to optimize outcomes. Our end-to-end solutions, including Hub and patient support services supporting life sciences, also empower clinical teams to seamlessly eliminate gaps in treatment.”

Key components of AscellaHealth’s comprehensive suite of Life Sciences solutions include:

  • Pre-commercialization and outsourced market access
  • Distribution partnerships, wholesale and 3PL services
  • National LDD fulfillment capabilities
  • Comprehensive Hub and patient support services
  • Streamlined prior authorizations
  • Technology-based patient engagement
  • Copay and financial assistance programs
  • Real-time Rx data and analytics
  • Drug rebate programs

Belazi adds, “Seamless medication access and adherence have a direct impact on patient outcomes, which is why a patient-first approach with end-to-end solutions throughout the product lifecycle help to ensure that products are readily accessed by prescribed patients, and that drug therapy is monitored for effectiveness, compliance and adherence to treatment.”

AscellaHealth will be attending Asembia’s Specialty Pharmacy Summit, Las Vegas, May 2-5. To schedule a meeting with AscellaHealth, please contact businessdevelopment@ascellahealth.com.

About AscellaHealth LLC
AscellaHealth is a global Healthcare & Specialty Pharmacy solutions organization serving patients, payers, life sciences and providers, offering a comprehensive portfolio of customized, tech-enabled specialty pharmaceutical and medical management services. An Inc. 5000 2021 winner, AscellaHealth’s unique, patient-centric approach supports its strategic partnership with Optime Care and is built upon proprietary technology processes for innovative programs and services optimizing health outcomes and quality of life for patients with complex chronic conditions or rare diseases that require specialty medications and/or gene and cell therapies. Visit www.AscellaHealth.com.

To view the original press release, click here.

aequum White Paper Offers Guidance on No Surprises Act (NSA) for Employer-Sponsored Health Plan Adminstrators: Risks and Opportunities

CLEVELAND–(BUSINESS WIRE)–aequum LLC announces the publication of its white paper No Surprises Act: What Every Plan Sponsor Needs to Know to serve as a valuable resource for employer-sponsored health plan administrators. It highlights many of the current risks and opportunities that result from the NSA legislation, including a focus on Reference-Based Pricing (RBP) strategies. Free download available here.

Jack Towarnicky, member of aequum, explains, “As of January 1, certain provisions of the No Surprises Act (NSA) took effect to protect health plan participants from balance bills received from out-of-network providers – including services for emergency care and at in-network facilities. It offers benefits professionals guidance regarding the NSA’s provisions and interim final rules – encouraging plan sponsors to respond with an approach that is both strategic and compliance oriented. A dual-approach will minimize compliance challenges, reduce cost of coverage for both the employer and employees, and improve both the perceived and actual value of health coverage.”

Main points of this whitepaper include:

  • The Independent Dispute Resolution (IDR) process added by the NSA triggers a new risk for health plans that use RBP with a network of providers or plans that directly contract with providers and facilities.
  • Providers may challenge RBP determinations even where the NSA doesn’t apply – such as for plans where there is no network of providers, where services are provided in a non-network facility, or by a non-network provider in a non-network facility.
  • Where the NSA does apply, out-of-network providers who challenge the RBP determinations shift the risk for charges in excess of RBP from the participant to the plan sponsor.

RBP may be subject to the NSA Independent Dispute Resolution process where plans directly contract with facilities and providers. Towarnicky points out that self-funded plans should be aware of this risk, adding, “The most effective way to address this legislation may be to adopt a pure RBP plan which will put the patient in the driver’s seat as a health care consumer.”

“RBP is one of the fastest growing solutions in health benefits cost management,” he continues. “It brings stability to health care prices and point of purchase cost sharing by using Medicare reimbursement rates and other provider cost data to provide an objective cost baseline. This offers disciplined pricing – fair and rational reimbursement for providers.”

About aequum LLC

Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum LLC helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. For more information, visit aequumhealth.com.

To view the original press release, click here.

Bipartisan bill aims to create incentives for mental health providers to adopt electronic records, health IT systems

By Robert King

FierceHealthcare.com—New legislation aims to ensure that mental health providers are not left out in the push to adopt electronic health records (EHRs) and other health IT systems.

The bipartisan bill introduced by Reps. Doris Matsui, D-California, and Markwayne Mullin, R-Oklahoma, aims to give targeted funding to providers and community mental health centers aimed at adopting health IT systems.

To view the original article in its entirety, click here.

How Population Health Can Help With Heart Disease

By David Levine

U.S.News.com— Heart disease has long been the No. 1 cause of death in the United States, accounting for approximately 1 in every 4 deaths each year, according to data from the Centers for Disease Control and Prevention. As with many health issues, heart disease can disproportionately affect certain demographic and socioeconomic groups, underscoring the sad adage that ZIP code is a primary risk factor for ill health.

To view the original article in its entirety, click here.

CDC Extends Federal Mask Mandate for Transportation into May

By Cecelia Smith-Schoenwalder

U.S.News.com— The Centers for Disease Control and Prevention on Wednesday extended the federal mask mandate for transportation, including on planes, trains and in airports, through the beginning of May.

The order was set to expire on April 18, but the agency wants more time to monitor for potential increases in severe cases of COVID-19 as infections rise. The order will now extend to May 3.

To view the original article in its entirety, click here.

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