A Role for Payers

Hypertension self-management: a home run for patients and payers.

Multiple Payers in Health Care: A Framework for Assessment

The starting point of the debate about the pros and cons of multipayer systems is the suspicion that in many health care systems, consumers do not get sufficient value for money. This contribution argues that one cause may be a nonoptimal choice of payment systems. Optimal payment of health care providers importantly depends on the amount of information available to the (prospective) patient. I...

Reimbursement To Private Payers ?

Leaders of health insurance companies, hospital systems, and physician organizations believe that when Medicare and Medicaid reduce payment rates to hospitals or physicians, these providers respond by raising prices to private insurers to offset a portion of the loss in revenue. This would mean that payment reductions in public programs contribute to increasing premiums for private insurance. B...

A report card for 32 payers: not making the grade.

Brandi White Y ou couldn’t make up stories like these: Shane Avery, MD, is a family physician practicing solo in Scottsburg, Ind. Earlier this year, his practice received a contract from a major health insurer offering a fee schedule based on 120 percent of Medicare rates. “It sounded fair, and we were about to sign,” Avery said, “but then we read further and found out it was based on 2004 Med...

Prescription opioid abuse: challenges and opportunities for payers.

OBJECTIVES Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Although difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local...