Lynn Carroll, COO of HSBloxThere is increasing recognition across the healthcare continuum of the link between patient behavioral health and clinical outcomes. Unfortunately, alignment between primary care physicians and services for mental health issues, substance use, and other social determinants of health (SDoH) too often range from poor to nonexistent. “Behavioral health factors have an outsized influence on morbidity and mortality, and are the source of a large portion of family physicians’ frustrations with the health care system,” writes the American Academy of Family Physicians. “It is common to have patients who are unable to access care for mental health or substance use due to lack of insurance coverage or access.” Underserved populations, such as rural Americans, suffer from health inequity issues because behavioral health support and services either are unavailable or not integrated with their primary care. As the National Institute of Mental Health notes, “Though the prevalence of serious mental illness and most psychiatric disorders is similar between U.S. adults living in rural and urban areas, adults residing in rural geographic locations receive mental health treatment less frequently and often with providers with less specialized training, when compared to those residing in metropolitan locations.”To encourage greater alignment of behavioral health and primary care, the Centers for Medicare and Medicaid Services (CMS) has created a primary care reimbursement model designed to promote more innovative, team-based, and equitable approaches to care. The ACO Primary Care (PC) Flex Model (which starts on Jan

Artificial intelligence (AI) is set to change the health insurance industry, potentially slashing costs and boosting revenues for payers grappling with economic pressures. As insurers face rising medical service utilization and provider costs and tightening Medicare Advantage reimbursements, AI and automation technologies offer a possible solution to improve efficiency and profitability. Payers could reportedly achieve “net savings of 13 percent to 25 percent in administrative costs and 5 percent to 11 percent in medical costs” by leveraging currently available AI technologies, according to Mckinsey Co. Furthermore, the report projects a potential “3 percent to 12 percent higher revenue” for insurers who fully embrace these innovations. For a growing number of doctors, AI chatbots that draft letters to insurers in seconds are reportedly expediting the fight to approve costly claims, achieving in minutes what years of advocacy have not. This technological shift comes as significant insurance companies face class-action lawsuits for allegedly using their technology to deny large batches of claims swiftly

What You Should Know:– Health insurance provider Humana Inc. announced the release of a groundbreaking Value-Based Care (VBC) Issue Brief focused on nephrology, the medical specialty treating kidney disease.– The issue brief report highlights the significant potential of VBC arrangements to improve patient outcomes and reduce healthcare costs for individuals with chronic kidney disease (CKD) and end-stage renal disease (ESRD).VBC: A Shift from Quantity to QualityVBC represents a paradigm shift in healthcare, moving away from fee-for-service models that reward the number of patients seen and procedures performed. Instead, VBC incentivizes healthcare providers based on patient outcomes and the quality of care delivered. This focus on results aligns well with the needs of CKD and ESRD patients, who require ongoing management and preventive measures.The Growing Challenge of Kidney DiseaseChronic kidney disease affects an estimated 37 million adults in the United States, often linked to conditions like diabetes and high blood pressure. Left untreated, CKD can progress to ESRD, requiring dialysis or a kidney transplant. According to theUSRDS 2021 Annual Data Report, the number of newly diagnosed ESRD patients has risen by 40% in a single year