The widely read list identifies what it says are the top pediatric hospitals that deliver high-quality care across multiple specialties.
Boston Children's Hospital once again tops U.S. News and World Report's Honor Roll of the nation's Best Children's Hospitals, on a list that, for the most part, has held steady from previous years.
This year's rankings name the top 50 centers in each of 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology.
The Best Children's Hospitalsmethodology factors measures such as patient outcomes, including mortality and infection rates, as well as available clinical resources and compliance with best practices, U.S. News said.
The magazine said it used RTI International, a North Carolina-based research and consulting firm, to collect and analyze data from children's hospitals and surveyed thousands of pediatric specialists.
More than 4 million people have lost coverage in the past two years, including many lower-income adults. That could prove problematic for safety net hospitals in the near future.
The ongoing efforts to destabilize the Affordable Care Act will adversely affect the operating margins of not-for-profit healthcare providers, according to a new analysis from S&P Global.
S&P analyst Allison Bretz said that over time, "a growing uninsured population could be a credit negative for not-for-profit hospitals and health systems, as these facilities would likely see an uptick in self-pay patients, charity care and bad debt."
Two years into the Trump administration's efforts to roll back the ACA, the uninsured population has risen from about 12.7% in 2016 to 15.5% in 2018.
A study by The Commonwealth Fund estimates that 4 million people have lost health insurance since 2016, and that the uninsured rate among lower-income adults rose from 21% in 2016 to 25.7% this spring.
"This will be most acute at safety-net providers and other providers with a high concentration of Medicaid patients, as that population is most vulnerable to many of these changes," Bretz said in remarks accompanying the report.
Beth Feldpush, senior vice president of policy and advocacy for America's Essential Hospitals, said the report "underscores concerns we’ve had since last year's attempts to repeal the ACA and, now, with piecemeal changes that have weakened the law."
"Many of the people who lose coverage seek care at our hospitals, which adds to uncompensated costs and puts more pressure on our members' already low operating margins," Feldpush said. "Because essential hospitals, by their mission, turn no one away, this could prove financially unsustainable for some."
Although active efforts to repeal the ACA in Congress have slowed in the past year, it is facing one of its greatest threats, as a federal judge in Texas hears a lawsuit brought by 20 states that challenges the constitutionality of the sweeping healthcare law.
For-profit, Payer Outlook Stable
While the rising uninsured rate could prove challenging for not-for-profit providers, S&P analyst David Peknay said it should have little effect on for-profit providers.
"The for-profit companies we rate have been reporting some increase in uninsured patients, consistent with national trends, but the impact on ratings is also currently immaterial," he said.
The losses in covered lives for health insurance companies is offset by other factors, said S&P analyst Joseph Marinucci.
"A key contributing factor is the sustained migration of the government-sponsored insurance segments toward coordinated care (Medicare Advantage and managed Medicaid), which is expanding the market opportunity for health insurers," Marinucci said.
"We expect ratings in the insurance sector to remain relatively stable in the near term despite the growth in the number of working-age uninsured individuals," he said.
Whistleblower lawsuits had alleged that the Florida-based wound care specialist knowingly filed bogus claims to Medicare for services that weren't needed.
Healogics, Inc. will pay up to $22.51 million to settle whistleblower allegations that billed Medicare for medically unnecessary and unreasonable hyperbaric oxygen therapy, the Department of Justice said.
Jacksonville, FL-based Healogics manages nearly 700 hospital-based wound care centers across the nation.
The settlement resolves allegations that from 2010 through 2015, Healogics knowingly submitted false claims to Medicare for medically unnecessary or unreasonable HBO therapy, DOJ said.
Healogics will pay $17.5 million, plus an additional $5 million if certain financial contingencies occur within the next five years, for a total potential payment of up to $22.51 million. The company has also has entered into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General.
"When greed is the primary factor in performing medically unnecessary health care procedures on Medicare beneficiaries, both patient well-being and taxpayer funds are compromised," said HHS OIG Special Agent in Charge Shimon R. Richmond.
The settlement came as the result of whistleblower lawsuits filed by a former executive at Healogics, and a separate suit filed by two doctors and a former program director who worked at Healogics-affiliated wound care centers. The four whistleblowers are expected to share $4.2 million of the settlement.
Healogics Responds
In a statment sent to HealthLeaders Media, Healogics said it settled the case "to avoid the additional cost, disruption and uncertainty of litigation."
"The matter being resolved related primarily to a disagreement over past practices involving complex Medicare coverage rules, which are continuing to be clarified by CMS's Medicare Contractors in the current environment. The settlement is not an admission of any wrongdoing or liability and there has been no determination of liability."
"Healogics' core competencies were not in question. Healogics was proud to be at the forefront of the CMS HBO prior authorization program, which allowed us to further develop differentiating support and compliance solutions for our customers in this complex coverage environment to ensure our patients are receiving the best clinical outcomes possible."
Rate filings suggest more plan choices in 2019, but if proposed exchange premiums are approved, a typical silver exchange plan will cost $98 more per month.
Proposed 2019 exchange premiums for silver health insurance plans are 15% higher, on average, than 2018 final premiums, new research from Avalereshows.
If approved, average silver-level exchange plan premiums will be $98 more per month in the states analyzed, up from $642 in 2018 to $740 in 2019.
These findings are based on an Avalere analysis of the complete 2019 individual market proposed rate filings released publicly by 10 states and Washington, DC.
"Insurers are starting to gain a better understanding of who is likely to buy their health insurance through the exchanges, but questions about the stability of the market remain," Avalere President Matt Brow said in a media release.
"This uncertainty is likely to contribute to substantial increases in exchange premiums across many states in 2019," he said.
Avalere blamed the premium hikes on:
The discontinuation of federal reimbursements for cost-sharing reduction plans and state strategies to allow insurers offering plans in the exchanges to recoup the lost reimbursements;
The repeal of the individual mandate beginning in 2019;
The lack of federal legislation to stabilize the individual market amidst enrollee risk and structural uncertainties.
Average premium rates increased in all states analyzed by Avalere, except Minnesota, where state officials attributed the premium decline to the state's reinsurance program.
CBO Projections
The Avalere projections are in line with those in a Congressional Budget Office report last month, which projected that the premiums for benchmark plans will increase about 15% from 2018 to 2019.
CBO blamed the premium hikes on three factors:
Insurers are no longer reimbursed for the costs of cost-sharing reductions through a direct payment;
A larger percentage of the population lives in areas with only one insurer in the marketplace;
Some insurers expected less enforcement of the individual mandate in 2018 —which would encourage healthier enrollees to leave the market.
Although premiums are going up, the Avalere study also found that consumers in seven of the 10 states examined will have more silver plan options to choose from in 2019 than in 2018.
In Virginia, for example, the average silver plan options per region will more than double. However, enrollees in the District of Columbia, Maryland, and Washington will likely have one fewer exchange option per region in 2019 than in 2018.
"The rate filings suggest we may see increased competition and plan choice in many exchanges in 2019," Avalere Vice President Kelly Brantley said. "Greater plan choice will allow consumers to select a plan that best meets their health coverage needs."
The feds are looking for guidance from stakeholders as they consider revisions to the 30-year-old Stark Law, which many believe to be outdated, inefficient, and a hindrance in the shift to value-based care.
The Centers for Medicare & Medicaid Services is considering revisions to the Stark Law banning physician self-referrals, and they're asking for input from stakeholders.
"In its current form, the physician self-referral law may prohibit some relationships that are designed to enhance care coordination, improve quality, and reduce waste," CMS Administrator Seem Verma said Wednesday in a blog post.
Building a value-based, patient-centered healthcare system will require that doctors and other providers work together with patients, Verma said, suggesting that the 30-year-old Stark Law is not in sync with the goals of coordinated care.
"Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value-based care and drive the Medicare system to greater value and quality," she said. "Medicare's regulations must support this close collaboration. The Stark Law and regulations, in its current form, may hinder these types of arrangements."
The RFI notes that CMS is "particularly interested in your thoughts on issues that include, but are not limited to, the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements, the need for revisions or additions to exceptions to the physician self-referral law, and terminology related to alternative payment models and the physician self-referral law."
Specifically, CMS is asking for suggestions about:
Existing or potential arrangements that involve federal payers and referring physicians that participate in alternative payment models or other novel financial arrangements, whether or not such models and financial arrangements are sponsored by CMS.
Exceptions to Stark that would protect financial arrangements between federal payers and referring physicians who participate in the same alternative payment model.
Exceptions to Stark that would protect financial arrangements that involve integrating and coordinating care outside of an alternative payment model.
Addressing the application of Stark to financial arrangements among providers in alternative payment models and other novel financial arrangements.
“We’re going to put together sort of an inter-agency group to start looking at this,” Verma said during an American Hospital Association webinar in January.
AHA President and CEO Rick Pollock said at the January webinar that Stark has made it difficult for hospitals to take advantage of the value-based payment opportunities in which CMS has been investing.
"They both present significant barriers to the implementation of some of these new, innovative models that reward coordination and reward value," he said.
Leaders react to the announcement that Boston-based surgeon, professor, and journalist Atul Gawande, MD, will serve as CEO of the retail giant's joint project with Berkshire Hathaway and JPMorgan Chase.
Initial reactions to the news that Atul Gawande, MD, has been named CEO of the joint healthcare venture being launched by Amazon, Berkshire Hathaway, and JPMorgan Chase was mostly enthusiastic.
Those who praised Gawande's appointment noted the thought leadership in his books and essays, as well as his hands-on experience helping U.S. health systems and international organizations innovate. Those who remained skeptical suggested the buzz may be overhyped.
"So we're officially running a passion project here not a business," Craig Garthwaite, associate professor of strategy and director of the Health Enterprise Management Program at Northwestern University's Kellogg School of Management, wrote in a series of tweets Wednesday.
Garthwaite took particular issue with the fact that Gawande will retain his positions as a practicing surgeon at Brigham and Women's Hospital and a professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School.
"This cannot be emphasized enough ... if the Amazon/Berkshire/Morgan venture is going to transform healthcare it will probably need a full time CEO. Unless CEO means something else in a 'disruptive' firm," Garthwaite wrote.
Others, however, expressed confidence in Gawande's ability to assemble a team to serve not only the employees of the companies behind this initiative but also to prompt wider spread change across the healthcare industry.
Marc Harrison, MD, president and CEO of Intermountain Healthcare: "With his outstanding skills and expertise, I believe he can help identify and implement solutions to help address the critical issue of the cost of care in this country," Harrison told HealthLeaders Media.
Bunny Ellerin, director of the Healthcare and Pharmaceutical Management Program at Columbia Business School: "This choice is brilliant," Ellerin said in a statement. "Dr. Gawande embodies exactly what we want in healthcare—a practicing physician with compassion, empathy and a patient-centered philosophy. He is someone who believes that we can do better and deliver improved healthcare if we focus on what’s important to the individual patient and to society more broadly."
Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association (MGMA): "This new venture has the potential to develop interesting new innovations for our industry that can help bring us closer to the medical practice model of the future, one that improves care while cutting costs," Fischer-Wright said in a statement. "We look forward to working with Dr. Gawande to realize that vision."
Donald M. Berwick, MD, a former administrator of the Centers for Medicare & Medicaid Services: Rather than a mere think tank, this will be "a do-tank," Berwick told The Boston Globe. "It's an activist move by organizations that really do want to make a change, and they have picked a leader in Atul Gawande who is almost uniquely capable of crafting the changes that are going to be need."
Andy Slavitt, another former CMS administrator, said Amazon and its partners made two wise long-term decisions Wednedsay.
"They set their health care effort up as a non-profit and aim to avoid profit making as an incentive. And they appointed public health expert, author & compassionate progressive physician to head it in @Atul_Gawande," Slavitt wrote in a tweet.
Editor's note: HealthLeaders Media senior news editor Steven Porter contributed to this report.
Supporters say AHPs offer affordable coverage alternatives for small businesses and individuals. Critics call the plans 'junk insurance' with narrow coverage that stick consumers with huge medical bills.
The Trump administration on Tuesday unveiled a final rule that allows small businesses to band together to create association health plans for employees that offer lower-cost coverage, but also provide fewer benefits than mandated under the Affordable Care Act.
Critics argue that AHPs offer coverage that's too limited, but proponents argue the more affordable alternative to ACA-compliant plans will offer much-needed relief to small businesses and individuals who need it.
"Many of our laws, particularly Obamacare, make healthcare coverage more expensive for small businesses than large companies," Labor Secretary Alexander Acosta said in amedia release.
"AHPs are about more choice, more access, and more coverage. The President's decision helps working Americans—and their families—purchase quality, affordable health coverage," he said.
The rules will be phased in over the coming months, and some AHPs could launch by September 1.
Consumer Protections
The Trump administration said that antidiscrimination protections that apply to large employer health plans will also apply with the AHPs. That includes prohibitions on cherry picking beneficiaries, charging higher premiums, or denying or canceling coverage based on pre-existing conditions, or if an employee becomes ill.
Those claims were dismissed, however, by critics. Families USA Executive Director Frederick Isasi called the AHPs "junk insurance"
"Because association health plans might appear like regular insurance but typically offer narrow coverage, many consumers who buy them will discover that they have astronomically high medical bills for charges they assumed would be covered by their health insurance," Isasi said.
Families USA and other critics have noted that the AHPs could be designed to keep people with preexisting conditions from buying the policies. That, in turn, would raise health insurance premiums for people buying standard coverage through the individual marketplace.
America's Health Insurance Plans (AHIP), which represents insurers, released a statement saying the final rule does offer some important consumer protections, including for those with preexisting conditions.
"However, we remain concerned that broadly expanding the use of AHPs may lead to higher premiums for consumers who depend on the individual or small group market for their coverage," AHIP said. "Ultimately, the rule could result in fewer insured Americans and may put consumers at greater risk of fraudulent actors entering this market."
Market Impact
The Congressional Budget Office last month estimatedthat more than 4 million people—mostly healthier, younger, and wealthier—could switch from ACA-backed health plans to cheaper AHPs in the coming months and years.
An analysis by Avalere Health in February projected that AHPs could lead to 3.2 million enrollees shifting out of the ACA's individual and small group markets into AHPs by 2022.
That migration to AHPs would bump up premiums for those remaining in the individual ACA market by 3.5% and increase small group ACA premiums by about .5%, compared to current law, according to Avalere's analysis.
"Consumers are always looking for a new low-cost health insurance option," Avalere President Dan Mendelson said in February, "but migration of healthy people to a new product will ultimately take a toll on what is presently being sold in the market."
The value-based primary care model focuses on relationships with care teams that include physicians, health coaches, behavioral health specialists, nurses, and a clinical team manager working together to treat the whole patient.
Boston-based Iora Health, the care team-oriented Medicare Advantage primary care provider, this month secured$100 million in funding to support its growth and technology platform.
Rushika Fernandopulle, MD, co-founder and CEO of Iora Health, spoke with HealthLeaders Media about the provider's plans for expansion, and the care model that he believes can transform healthcare delivery.
The following is an edited transcript.
HLM: You say your model is unique. How so?
Fernandopulle: We obviously think we are unique, although increasingly the rest of the world is figuring out that we're going in the right direction. We're saying that if we want to change healthcare, then we have to change how actual people get actual care, not just nibbling around the edges. A good place to start is primary care.
The primary care model, which is take-a-number reactive and receive-a-service transactional, isn’t what we need. What we need is a radically different model that is relational. And that is what we are doing.
The worst thing to do is try to do both at the same time, which is what a lot of providers are trying to do. Try to do fee-for-service with the same processes as a version of what we are doing. Our big advantage is focus. This is a new model of care and it's all we're doing. There is a small number of us who are de novo start-ups who want to change healthcare with a different business model.
HLM: Why the focus on Medicare Advantage?
Fernandopulle: Because our model is a relationship-care model we have to get paid differently. That is the whole point. By and large we work with Medicare Advantage plans and serve their members so we can contract in a value-based way, not a volume-based way.
HLM: Does the Iora model cherry pick its patients?
Fernandopulle: We're not cherry pickers. Whatever the opposite of cherry picker is, that's what we're doing. We go to places that have older, sicker people, and that's correlates with lower income, because we think we can help them.
So, we go to Phoenix, where we have a number of practices. We're not in Scottsdale, where the rich people live. We're in places like Indian School, where lower income, tend to be sicker, older people live. The model works great, maybe even better for people the sicker they are.
HLM: Could the Iora model work with traditional Medicare?
Fernandopulle: We have to get paid differently to make these models work. We are limited from working with traditional Medicare at the moment, because of the current payment model. Hopefully, some day that will change.
HLM: What metrics do you use to gauge success?
Fernandopulle: We look at the quintuple aim. We look at patient experience, because we are a service business and we need to get patients to vote with their feet.
No. 2 is improving health outcomes. We are a healthcare delivery company.
No. 3 is we need to impact total cost of care. So, people getting the care they don't want or need is not just harmful but wasteful. We see big drops in total spending by keeping people away from stuff they don’t need.
No. 4 is joy in practice. We need to do it in a way where our teams, and in particular our doctors, are happier.
And No. 5, we need to do it in an economically sustainable way. We actually have practices that don't lose money. We do well in all five of those and we can do better in all five of those. What we're doing, and what we are using our funds for, is to continue to build out our infrastructure and the way we do things to be able to perform better on those five metrics.
Our big advantage is we're trying to fix the right things. We're not trying to generate volume, or use higher codes or play coding games or any of that stuff. We're trying to improve people's health and build systems to help us do that. We are fighting the right fight.
HLM: What is Iora's relationship with its physicians?
Fernandopulle: They all work for us. We are building practices. We install the IT platform, and the software for the Iora-affiliated physician groups. This is not a loose network. We feel like we need to build a new model and have it be consistent. It means we can figure out the right way to do things and we can actually do it.
HLM: What will you do with this $100 million investment?
Fernandopulle: Several things. One is we will continue to improve our infrastructure on the people side and the technology side. We made the decision early on that we have to build a different technology platform to do this kind of care.
The existing electronic health records are, not surprisingly, built to power the old system to make the bills higher. We don't care. We don't think that adds value. What we need is a system that will help us engage patients, improve health. And to do that we have to build a different technology platform.
No. 2 is we will continue to invest in growth. We are doubling in size each year. We are opening a number of new sites. We will continue to grow and increase our impact across the country.
HLM: Where do you see Iora in five years?
Fernandopulle: Our mission is to transform healthcare. It's not just about providing care for the people who happen to be our patients. We need to kick the industry in the behind and say that the way we are doing it now doesn't work and we need to change. We need to raise the bar.
We hope we will be bigger and have more patients, but we also hope to have an impact on the rest of the industry and get them to move in this direction.
HLM: Will the investors influence your business decisions?
Fernandopulle: No! We run the company. They are investing because they think what we are doing is the right thing to do and beneficial. We are obviously open to getting people's input, but they don’t get to tell us what to do.
HLM: What was the elevator sales pitch to investors?
Fernandopulle: Simply that this is the biggest business and moral imperative in the country, and maybe the world; the gap between the $3.3 trillion we are spending on healthcare, and what we are getting in return. If you want to address that, this is a huge opportunity.
Let's stop dancing around the edges, and provide actual people with actual care, and primary care is a good lever to do that.
The impact of tax reform and an overall improvement in earnings resulted in a favorable change to capital and surplus in 2017 of almost $8.8 billion for the aggregated Blues.
It looks like 2017 was a good year for the nation's Blue Cross Blue Shield companies.
A new study from A.M. Best shows that the Blues saved $2.3 billion in 2017 thanks to changes enacted in the Tax Cuts and Jobs Act.
The Blues reported a total change of $4.7 billion to their net deferred income tax on their 2017 year-end statutory statement. That included a "favorable impact to the net deferred income tax compared with $854 million at year-end 2016."
"However, due to the impact of the TCJA many of these companies also reported a negative change in the value of the deferred tax asset, which partially offset the change in the net deferred income tax," the analysis found. "The net effect was a positive $2.3 billion for the Blues in aggregate."
Of the non-profit Blues that saw a favorable net impact to their capital and surplus, as a result of the changes from the TCJA on their 2017 year-end statutory statement:
Health Care Service Corp., saw a net effect of $1.1 billion;
Two companies—Blue Cross Blue Shield of Michigan and Horizon Healthcare Services—had positive effect in excess of $300 million, and several others had a favorable net impact greater than $100 million.
Overall, the analysis found that the impact of tax reform, combined with an overall improvement in earnings, resulted in a favorable change to capital and surplus in 2017 of almost $8.8 billion for the aggregated Blues.
"The combination of strong 2017 earnings with this sizable unexpected positive impact from the TCJA for 2018, as well as several future years, has prompted some Blues to announce major initiatives to direct part of the unexpected income toward the benefit of their members," the analysis said.
In February, Horizon Blue Cross Blue Shield of New Jersey said that its 3.8 million customers will get $150 million in direct "relief" in 2018 as their share of the health plan's $550 million windfall generated by federal tax reforms.
Another $125 million in Horizon's tax savings would go toward long-term initiatives to improve access to behavioral health, primary care, and substance abuse services, and $275 million will be set aside in case Congress takes it back.
Along with the good news, A.M. Best warned that "longer-term commitments to outside causes or insufficient rates may put pressure on the future results should market conditions deteriorate."
"Furthermore, action or pressure from state regulators to spend all or a portion of the tax savings from the TCJA may reduce the benefits in the future," the analysis said. "Despite the unanticipated financial windfall from tax reform, A.M. Best expects the affected Blues will continue to balance growth and profitability to sustain future capital levels."
HCSC Responds
Health Care Services Corp., one of the big winners in the tax cut, said the windfall will be used to improve the insurer's capital position, but that "it is one factor, among many, in our overall financial performance. Tax events do not drive our long-term strategy."
The company said it saw $971 million of its 2017 tax benefit in statutory reserves, in line with guidelines.
While this seems like a large number, HCSC said, the insurer buys and administers approximately $70 billion in healthcare goods and services on behalf of 15 million members each year.
The company also launched a three-year, $1.5 billion Affordable Cures initiative to accelerate healthcare cost reductions for consumers.
The employer medical cost trend has stabilized at about 6% annually through 2019, but that's still unsustainable and well out of line with the Consumer Price Index and wage increases, PwC says.
The annual rate of growth in employer medical costs has plateaued at about 6%, which is half the rate of growth seen a decade ago, thanks largely to the rise of high-deductible health plans.
However, squeezing cost reductions from reduced utilization that come with high-deductible plans may have played itself out, according to a new study from PwC, which means that employers and health plans looking to slow cost growth will have to focus on medical pricing.
Rick Judy, a partner at PwC, says high-deductible plans largely accomplished what they set out to do, as employer annual medical costs trends have fallen from 11.9% in 2008 to around 6% most recently.
"When you have very low-deductible health plans, consumers operate within the healthcare ecosystem in a way that doesn’t allow them to take costs or utilization into the equation," Judy says.
"As health plans and employers have put high-deductible health plans in place, consumers are becoming better shoppers with their healthcare dollars, and the healthcare medical cost trend has seen a steep decline over the past decade because of the utilization changes," he says.
Now, that savings generated by reduced utilization from high-deductible plans "has sort of played out," Judy says.
"We've seen a plateauing of the adoption of those and the impact that they can have on the overall utilization has run its course as well," he says. "That means that we have to tackle next is prices, and hopefully that won't take 10 years."
Judy identified key "inflators" of medical costs through 2019.
The rise of care venues: "As we put a lot of new care venues in place, whether those are virtual, or alternatives to emergency rooms or other high-cost venues of care, we are finding there is a slight uptick in how readily accessible care is and because of that consumers are utilizing the healthcare system more and more as that care is more readily available," Judy says.
Provider mega mergers: "We are continuing to see that. We've moved to where 93% of metro markets are going to be highly concentrated with providers in 2019," Judy says. "In these larger mergers we saw 10 provider deals over $1 billion this past year. That gives providers better negotiating leverage around prices. So, that is going to continue to put upward pressure on medical cost trends into 2019.
Physician consolidation: "A greater percentage of physicians being employed by hospitals versus being in stand-alone situations," Judy says. "Those situations typically bill out at a higher rate than a stand-alone physician. Also, there is a decrease in efficiency. On an average day, a stand-alone physician sees about 23 patients a day and an employed physician sees about 20 patients per day."
Working to contain costs are "deflators," which Judy identified as:
The rise of care advocates: Employers and health plans are offering their employees and policy holders consumer advocates to who can help them navigate the healthcare landscape to the best care at affordable prices.
High-performance Networks: Limited networks will emphasize quality and patient satisfaction along with savings. Employers are leveraging their buying power to negotiate directly with providers to create these high-performance networks.
In addition, Judy says the just-completed flu season was the worst in years and contributed to rising utilization and care costs. The 2018-19 flu season is projected to be closer to average and should slightly dampen the flu's effect on trend in 2019.
