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White Papers from Our Members
Sellers Dorsey is a national health care consulting firm that helps clients navigate the ever-changing health care landscape by providing a range of consulting services in Medicaid, as well as custom Medicaid financing solutions. Since 2000 we have consulted on a range of financing, policy, and operational projects in nearly 40 states, delivering a fully integrated suite of services to a wide array of clients. We help clients in multiple areas of expertise, such as delivery system reform, Medicaid financing, program administration, quality improvement strategies, and health care advisory. Sellers Dorsey is home to former state Department of Human Services and Medicaid officials, former Medicaid directors, and industry executives with expertise in the development and implementation of reimbursement, financing, administration, and quality improvement strategies, along with highly qualified project management and research staff. Our team’s diverse background enables us to appreciate and navigate each client’s unique path to success.
Sellers Dorsey on behalf of Pyx Health has provided a white paper study on Banner University Health Plans, Arizona (BUHP), which covers over 200,000 Medicaid, Dual Eligible Medicare, and Long-Term Care lives. In 2018 Arizona integrated behavioral health care into their traditional Medicaid program. This prompted BUHP to search for new approaches to address the whole-person needs of their members with a focus on key drivers of avoidable utilization—behavioral health conditions and social barriers to care. The purpose of the study was to analyze the utilization patterns and medical expense of both general mental health conditions, such as anxiety and depression, and serious mental illness on increased medical expenditures, including general hospital admissions and emergency department use. To learn more read the Pyx Health Expands Banner University Health Plans’ 24/7 Care Team To Decrease Medical Spend Among High-Utilizing Members white paper.
Please note: This information represents the views of the author, not the Ohio Association of Health Plans (OAHP). The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.
Sarepta Therapeutics is at the forefront of precision genetic medicine, having built an impressive and competitive position in Duchenne muscular dystrophy (DMD) and more recently in gene therapies for 6 Limb-girdle muscular dystrophy diseases (LGMD), Charcot-Marie-Tooth (CMT), MPS IIIA, Pompe and other CNS-related disorders, totaling over 20 therapies in various stages of development. The Company’s programs and research focus span several therapeutic modalities, including RNA, gene therapy and gene editing. Sarepta is fueled by an audacious but important mission: to profoundly improve and extend the lives of patients with rare genetic-based diseases.
The purpose of the Sarepta Therapeutics white paper is to provide a rational and feasible approach to monitoring patients with Duchenne muscular dystrophy (DMD) in a clinical setting to better assist providers and insurers in assessing response to treatment compared to the natural history of DMD. Patient groups with different genetic mutations vary in their expected rates of decline, so genotype-specific natural history should inform evaluations when available. To learn more, read the Outcome Measures for Patients With Duchenne Muscular Dystrophy white paper. For additional information or questions you may contact Kristie Bryerton, Director of National Accounts for Sarepta Therapeutics. Ms. Bryerton may be reached electronically at: kbryerton@sarepta.com or by phone: (570) 916-3247.
Please note: This information represents the views of the author, not the Ohio Association of Health Plans (OAHP). The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.
CAQH is a non-profit alliance that creates shared initiatives to streamline the business of healthcare.
In Medicaid programs across the nation, inefficient administrative processes are time-consuming, costly and frustrating to plans, providers and beneficiaries. Rectifying them requires a thoughtful approach to business process automation, standardization and collaboration. But, for it to be successful, the state must reduce administrative burdens and improve efficiency throughout the system.
The Ohio Department of Medicaid (ODM) has been working to transform the program by introducing a seamless service delivery system and improving service to beneficiaries. Read the full white paper by CAQH identifying the benefits of automated administrative processes for MCOs, providers and beneficiaries and the opportunities for Medicaid plans to streamline: centralized credentialing, improving prior authorizations and reducing Medicaid waste.
Please note: This information represents the views of the author, not the Ohio Association of Health Plans (OAHP). The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.
Propeller’s mission is to make life better for every person and community affected by chronic respiratory disease. Propeller has validated its approach, platform, and products in more than 35 peer-reviewed clinical studies. Read about Propeller’s success stories from partnering with Cincinnati Children’s Hospital and a national health insurance company.
Propeller Health is a leading digital health company dedicated to the management of chronic respiratory disease. Propeller develops products that help people with asthma or COPD manage their condition in partnership with their healthcare provider. The Propeller platform is used by patients, providers and healthcare organizations in the US, Europe and Asia. Propeller Health is a wholly owned subsidiary of ResMed.
Please note: This information represents the views of the author, not the Ohio Association of Health Plans (OAHP). The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.
Health Care Glossary
A person who receives benefits of any insurance plan or policy.
An employee or other insured named under a group health insurance policy.
A request for payment for services.
A specified dollar amount or percentage of covered expenses that an insurance policy or Medicare requires a beneficiary to pay toward eligible medical bills.
Federal law requiring that workers who end employment for specified reasons have the option of purchasing group insurance through the employer for a limited period of coverage (usually 18 months, but in some cases, 29 months or 36 months).
Provisions and procedures used by insurers to avoid duplicate payments when a person is covered by more than one policy.
Services for which an insurance policy will pay.
A specified dollar amount of medical expenses that the beneficiary must pay before an insurance policy will pay.
A procedure or condition that an insurance policy does not cover.
Medical treatment that is not generally accepted within the medical profession. Insurance policies often do not cover these procedures.
A statement from an insurance company showing which payments have been made on a claim.
Traditional insurance that does not place restrictions on which doctors you can use. The insurer pays for the expense incurred.
A contract between an insurer and an employer or association.
Federal law that guarantees health care plan eligibility for people who change jobs if the new employer offers group insurance.
A term for managed care insurers in Ohio. HICs include all Ohio HMOs and other companies that offer prepaid managed care.
A contract between an insurance company and an insured person.
A person who has been admitted to a hospital or other health care facility to receive diagnosis, treatment or other health services.
An individual or organization protected by an insurance policy.
The medical and social care given to one who has a severe chronic impairment over a long period of time.
A term traditionally confused with the term HMO. A general term used to describe a system that focuses on improving quality and controlling prices. Managed Care includes HMOs, PPOs and POS plans.
Treatments or services an insurance policy will pay for as defined in the contract.
A period of time when new subscribers may enroll in a health insurance plan regardless of their health.
A patient who receives care at a hospital or other health care facility without being admitted to the facility. Outpatient care also refers to care given in other locations such as outpatient clinics.
Requires an insured to obtain the insurance company’s approval before a medical service is provided. If the insured fails to follow the pre-certification procedures, the company may reduce or deny claim payment. Getting pre-certification does not guarantee claim payment.
Money paid in advance for insurance coverage.
Health insurance policy that pays first when a person is covered by more than one insurance plan.
A person or organization that provides medical services, such as a doctor, hospital, x-ray company, home health agency, pharmacy, etc.
Applies only when the insured has more than one health insurance plan. The secondary payer is the plan whose payments cannot be made until another plan (the primary payer) has processed the claim. (Also see Coordination of Benefits)
An organization (usually an employer) that pays health care costs out of the organization’s own pocket.