Elevance Health Public Policy Institute

Efforts employed by pharmacy benefit managers (PBMs) to combat fraud, waste, and abuse have evolved beyond compliance functions into strategic programs that improve clinical outcomes, reduce unnecessary spending, and enhance patient safety. A new report examines how PBMs such as Elevance Health’s CarelonRx are reducing the incidence of prescription drug-related fraud, waste, and abuse and mitigating its impact on clinical quality and healthcare spending and value. 🔗 Read more: https://lnkd.in/ec2tE-Ku

Elevance Health’s program integrity framework prevents, detects, and recovers inappropriate Medicaid spending by emphasizing front-end controls for prevention, provider engagement, and investigation of fraud, waste, and abuse. As Medicaid programs continue prioritizing payment integrity, managed care organizations like Elevance Health can effectively shift focus from recovering improper payments to preventing them, in turn improving payment accuracy, reducing administrative burden, and safeguarding taxpayer resources. 🔗 Read more: https://lnkd.in/gsFGpAS6

New research from the Elevance Health Public Policy Institute found that that nearly 70% of disputes submitted to the #NoSurprisesAct independent dispute resolution (#IDR) process are either out of scope or ineligible, but only one third of these are dismissed by IDR entities. Out-of-scope or ineligible disputes that are not dismissed contribute to unnecessary increases in healthcare costs. 🔗 Read more: https://lnkd.in/e66qCjAB

Adult dental benefits are optional under #Medicaid, leaving many adults without consistent access to preventive oral healthcare. Our research suggests that dental value-added benefits (VABs)—which can be offered by Medicaid managed care plans—are a meaningful and flexible way to fill those gaps and expand access to essential dental services. Among members who used a dental VAB, 89% received a dental exam, 76% received dental x-rays, and more than half received a cleaning—demonstrating how these benefits are translating into access to essential care. 🔗 Read the full paper: https://lnkd.in/eT6RabiE

Take-home methadone can offer people with opioid use disorder greater flexibility in accessing treatment—and recent PPI research suggests expanded access to take-home treatment can do so without increasing adverse outcomes.   The study found that greater county-level uptake of take-home methadone was not associated with statistically significant increases in overdose, hospitalizations, or emergency department visits. These findings add to the evidence supporting take-home methadone as an option for expanding access to treatment. https://lnkd.in/ekpvS3a3 #NationalRecoveryMonth #OUD

Telehealth has the potential to bridge geographic barriers to care—but our recent study found that telehealth use by rural residents lags that of non-rural residents across all chronic conditions and sources of insurance coverage.   As the figure shows, telehealth use was consistently lower in rural areas across Commercial, Medicaid, and Medicare coverage. Our report further explores these trends and opportunities to better understand what may be driving the divide.   🔗 Read the full report: https://lnkd.in/egr-sTfb

Dual eligible beneficiaries are more likely than Medicare-only beneficiaries to experience significant health challenges and health-related social needs. Yet, navigating two separate programs can contribute to fragmented care, making it harder to access the benefits and care they need.   A new paper from the Elevance Health Public Policy Institute examines how Dual Eligible Special Needs Plans (D-SNPs) can better coordinate Medicare and Medicaid benefits and outlines flexible pathways for states to advance greater integration.   🔗 Read more: https://lnkd.in/g3N7gim8

New research from the Elevance Health Public Policy Institute examines the use of healthcare services during the first year postpartum by women with Medicaid coverage. Using Medicaid claims and enrollment data from Elevance Health-affiliated plans, the study found that women continued to use needed healthcare services beyond the traditional 60-day postpartum coverage period, underscoring the importance of the American Rescue Plan Act-authorized option to extend postpartum Medicaid coverage to 12 months. 🔗 Read the full study: https://lnkd.in/eeGHGj3Z

Emergency ground ambulance charges are rising, and in the absence of surprise billing protections, consumers who use out-of-network ambulances are paying more.   Our analysis found that from 2012 to 2025, charges for emergency ground ambulance services increased over 30% above medical inflation, while allowed costs increased just 3–6%.   That widening gap matters. Because ground ambulances aren’t covered by the federal #NoSurprisesAct, states are considering how to protect patients from surprise bills while setting fair reimbursement. This research offers evidence to help them do both without unnecessarily increasing healthcare costs. https://lnkd.in/eVGTsWpM

Is telehealth expanding access to virtual care for chronic conditions for people living in rural communities? Recently, Sarah Adkins, PPI Director of Public Policy, joined Elizabeth Casolo & the Becker's Healthcare Podcast to discuss this topic, highlighting PPI’s most recent paper on telehealth use in rural communities. Their discussion explores differences in telehealth use between rural and non-rural populations, barriers contributing to those gaps, and opportunities to improve access going forward. 🎧 Listen to the conversation: https://lnkd.in/eVvkHkDM