In early April, the Centers for Medicare and Medicaid Services (CMS) finalized the 2025 Medicare Advantage Rule. This legislation also included changes to Medicare Part D, which covers prescription medications. Many health care organizations were expecting updates...
Medicare Advantage Spending Surge: What the 2023 Data Reveals & What Your Health Plan Needs to Know
A review of last year’s data shows a spike in service utilization for members with Medicare Advantage (MA) plans in 2023. This information came from an AHIP survey, which found that total medical expenses in the fourth quarter were up 8.1% compared to the same time in...
Inaccurate Reports of Vaping History Impacting Health Insurance Premiums
Vaping has been highly criticized due to its negative health effects, especially as the Food and Drug Administration (FDA) has cracked down on banning flavored e-cigarette products. As vaping use has increased among adolescents and young adults over the past decade,...
Proposed Federal Legislation Intended to Expedite Prior Authorization Approval Process
Recent legislation proposed by the Biden administration aims to address member dissatisfaction with insurance approval wait times. If passed, this rule will apply to prior authorization requests through government insurance plans and could go into effect starting in...
Safeguard Your Pharmacy Reimbursement and Avoid Audits
With ongoing medication shortages and astronomical costs for specialty drugs, nearly all members can benefit from medication savings. Furthermore, managing costs helps payers keep reimbursement rates steady for their partners. TOG has identified several tools that can...
Prepare for Medicaid Access Changes: What Your Health Plans Need to Know Now
Network inadequacy can create a big headache for health plans, so payers should give special attention to any legislative changes (either proposed or finalized) to these policies. One potential change is related to Medicaid and managed care access standards. Since the...
Infectious Disease Cases are Rising: How Can Your Health Care Provider Network Act as a Buffer?
Estimated Read Time: 5 Minutes Learn how your health care provider network can: Identify community hot spots & engage vulnerable populations. Craft engaging educational content for optimal reach & impact. Boost patient engagement & safety through testing...
Preventive Vision Care Can Lead to Better Brain Health Outcomes
A new study from the Journal of American Medicine: Ophthalmology shows that all types of visual impairments are associated with a higher risk of dementia. Between 12 and 32% of individuals with visual impairments are also diagnosed with dementia. This variation in the...
Insurer Considerations Becoming Crucial Amid Wearable Technology Growth
Wearable technology has become a staple in many American households over the past few years. Fitness trackers are especially popular among individuals looking to monitor their basic vital signs and increase their physical activity. Wearable technology has even become...
Optimize Your Health Plan’s Provider Network With Our Comprehensive Guide
A high-performing provider network is essential for a successful health plan. It can help you attract and retain members, improve quality outcomes, reduce costs, and bolster financial performance. However, moving to a more productive provider network can be a complex...