#DYK? Between 2003 and 2023, Massachusetts health plans and employers have expended over $4.9 billion on taxes & assessments to fund state programs such as MA’s Universal Immunization Program & the MA Child Psychiatry Access Project.

Health plan reserves are critical in protecting members, providers & the whole MA healthcare system: Health plan reserves guarantee continuity of care for consumers & ensure sufficient capital exists to pay claims to providers, insulating the healthcare market from disruption.

Unchecked hospital mergers increased health costs, study finds

Podcast Alert! @MAHPHealth
President & CEO Lora Pellegrini joined @HealthBizBlog
to talk about the affordability challenges facing Massachusetts employers and consumers when it comes to health care.

Tune in to hear her thoughts:

#DYK? Health plan prior authorization processes are based on national & local standards of care & the latest peer-reviewed, evidence-based clinical guidelines. Prior Auth is not designed to deny care, but to maximize patient safety, quality & affordability.

Restricting a health plan’s ability to conduct prior auth removes their ability to effectively ensure safe, evidence-based, affordable care. #DYK? A @Milliman report found removing prior auth will result in $2.2-5.6 billion in yearly additional premium costs for MA consumers.

The right care, at the right time, in the right setting: Health plans’ prior authorization processes are used on a limited set of services, mostly for high-risk & high-cost treatments, tests or Rx drugs, to ensure patient safety, avoid unnecessary care & promote affordability.

#DYK? @CDCgov found that medical errors are the 3rd leading cause of death in the US. In 2017 @BetsyLehmanCtr found MA alone had 62,000 medical errors accounting for $617 million in excess costs. Prior auth allows health plans to ensure patients receive safe, evidence-based care.

New research from Oliver Wyman finds that provider markups on specialty drugs increased 2024 commercial health insurance premiums by $13.1 billion in 2024. On average, providers charge 42% more than a specialty pharmacy for the same drug.

Read more: https://shorturl.at/bHLZ4