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Tag: health insurance companies

5 Steps Health Insurance CEOs Must Take to Help with COVID-19

By JEFF LIVINGSTON, MD

Imagine a country where you can not see a doctor. Who will refill your blood pressure prescription, see your sick child, mend your broken arm, deliver your baby, or run the ventilator if you fall victim to Coronavirus? The COVID-19 pandemic created a cash-flow crisis causing mass physician layoffs and closure of medical practices. A world without doctors puts us all at risk. The pandemic is the invisible enemy, and the CEOs of large insurance companies have the tools to help doctors stay in the fight.

Our government, healthcare providers, and individuals are doing our part to flatten the curve of the pandemic. It is time for the insurance industry to take massive action to salvage the US health system.

Practices are closing already. Tenet Health care announced a $250 million dollar reduction effective March 27, 2020. Other large and small health systems are implementing drastic cost-cutting measures. Data reported in USA Today, an estimated 60,000 family practices will close and 800,000 of their employees will lose their jobs by the end of June.  

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The Digital-First Health Insurance Startup Changing Healthcare in Nigeria | Femi Kuti, RelianceHMO

By JESSICA DaMASSA, WTF HEALTH

RelianceHMO is a Nigerian-based health insurance startup that aims to turn the traditional health insurance world upside-down. CEO Femi Kuti delves into how his company is using mobile phones, telemedicine, data science, and even underwriting (!) to make health insurance cheaper — and more accessible. With more than 1800 hospital partners across Nigeria, RelianceHMO is making a name for itself, but how does it plan to scale throughout Africa? And, what can payers around the world learn from their approach as they seek to make health insurance easy and affordable for Nigeria’s 190M uninsured? We love talking about disrupting payment models in healthcare and after hearing Femi’s story, you’ll understand why.

Filmed at Bayer G4A Signing Day in Berlin, Germany, October 2019.

Part 2: Bypassing Prior Authorizations

By NIRAN AL-AGBA, MD

A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed Ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.

The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for Ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can fill prescriptions for certain drugs, PAs boil down to yet another cost-cutting measure implemented by insurers to stand between patients and certain costly drugs.

The PA process usually takes from 48-72 hours, and it’s not infrequent for requests to be denied, even when the physician has demonstrated an undeniable medical need for the drug in question.

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