Entries in Thayer, Claire (100)

Thursday
Jan222015

Population Health Management - Integration of Medical and Pharmacy Benefits 

By Claire Thayer, January 22, 2015

A new Blue Cross Blue Shield Association (BCBSA) and Prime Therapeutics LLC (Prime) study examined yearly medical costs of 1.8 million members of Blue Cross® and Blue Shield® (BCBS) independent companies, whose pharmacy benefit services were divided between “carve-in” and “carve-out” benefit options.  This study finds that members integrating the pharmacy benefits experienced:

  • 9% fewer hospitalizations
  • 4% fewer emergency room visits
  • 11% lower medical costs

HealthPartners, in their Pharmacy Integration Study, estimated that integrating medical and pharmacy benefits can save a group with 9,000 continuously enrolled members more than $1 million per year.  These and other data points are featured in MCOL’s infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Thursday
Dec112014

Pitfalls with Health Care Provider Data

By Claire Thayer, December 11, 2014

A U.S. Senate Committee investigation report finds that Medicare paid 478,500 claims attributed to deceased physicians, totaling up to $92 million, from 2000 to 2007. The U.S. Postal Service reports that at least 25-30% of the demographic and contact information for health care providers changes every year. The cost of bad or outdated provider data is estimated at $26 billion annually. These and other data points are featured in MCOL’s infoGraphoid this week:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Wednesday
Nov192014

Health Care Fraud Detection: Intersection of Data and Linking Analytics

By Claire Thayer, November 19, 2014

LexisNexis tells us that three key elements of successful link analysis are Big Data, Super Computing and Social Network Definition and that the three big data necessary for successful link analysis include claims data, provider data and member data.  In August earlier this year, LexisNexis hosted a webinar, Moving Fraud Prevention Forward: The Intersection of Data and Linking Analytics.  Throughout this webinar, the audience engaged in several polling questions - these questions, along with the audience responses are featured in MCOL’s infoGraphoid this week:

MCOL's weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Wednesday
Nov052014

US Healthcare Spending Waste, Unnecessary Cost, and Fraud

By Claire Thayer, November 5, 2014

The United States spends almost $3.8 trillion annually on healthcare – or 18% of GDP. Of this amount, almost one-third of healthcare spending is estimated to be attributed with waste, unnecessary services and fraud. MCOL’s infoGraphoid this week highlights some of the major types of waste, estimated number of unnecessary surgeries, new healthcare fraud investigations and more:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Wednesday
Oct152014

Population Health Management Costs & Risks

By Claire Thayer, October 15, 2014

Chronic disease is defined as a long-lasting condition that can be controlled but not cured.  In the United States alone, 75% of our healthcare spending is now directed towards the treatment of chronic disease.  Studies find that almost 50% of this population copes with at least one chronic condition.  MCOL’s infoGraphoid this week highlighted these trends, along with a recent study published in the journal Health Affairs  on the cost impact of disease management and components of Pepsico’s wellness program focused on reducing employee costs and hospital readmissions:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.