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...
How Insurers Can Minimize Effects of Unexpected Medication Shortages
Many companies (including but not limited to health care organizations) experienced the negative effects of supply chain shortages during the COVID-19 pandemic. However, there are other reasons for such supply issues. The most recent shortage has impacted many...
Out-of-network: What Does it Really Mean for Members?
Most people who have health insurance are at least somewhat familiar with the term 'out-of-network.' Those who work in the health insurance industry likely explain this concept to members often. While many people know that out-of-network refers to providers and...