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Responding to Transformative Change in Healthcare

Today's healthcare sector is facing unprecedented challenges as it undergoes transformational change in the post Affordable Care Act (ACA) environment. Healthcare organizations are attempting to execute strategies designed to enhance their organization's ability to achieve high quality, cost efficient care, even as they are confronted with unrelenting public policy and regulatory challenges.


Supreme Court Affirms Affordable Healthcare: Time to Move On

In June, the Supreme Court decided in favor of the federal government in yet another challenge to the Affordable Care Act.


Healthcare Billing Under the Regulatory Microscope

Today, healthcare providers face heightened financial risk as their billing practices come under increased scrutiny.  Federal and state government regulators are dedicating unprecedented resources to recover monies paid under Medicare, Medicaid, and TRICARE (the health care program for the military) reimbursement programs.  Commercial payors also are investigating provider billing procedures to detect improper coding and double-billing practices.   Healthcare fraud recoveries reach into the billions of dollars annually to restore valuable assets to federally funded programs and prevent billions more in losses.


Telehealth Care Platform Presents New Insurance Challenges

Telehealth is a burgeoning industry in markets worldwide. The global telemedicine industry is expected to reach $35 billion by 2020. Medical industry statistics project that telemedicine consultations will surge to 160 million cases by 2020, a 700 percent increase since 2015.


Increased Loss Severity in Healthcare Liability Claims

The principal challenges faced by healthcare liability insurance carriers have remained constant since the crisis of the late 2000s, including poor investment returns, decreasing premiums, eroding rate, and expanding coverage demands.  Today, these challenges are being exacerbated by the continued consolidation of the healthcare sector, as well as increased loss severity.  Meaningful pricing correction is needed.  


Lottery Mentality of Today’s Juries – How Much is Enough?

People’s perspective of what is a lot of money continues to escalate. How much is enough? How much is too much? Never has this lottery mentality been more on display than in recent jury awards related to healthcare lawsuits. While the frequency of healthcare professional liability claims may have stabilized or even shown slight declines, the increased severity of such claims has been staggering.


Robotics in the Operating Room Gives Surgeons Greater Control, Improves Patient Outcomes

They’re here.  Robotics in the operating room is happening now and is the fastest growing segment within the healthcare medical device sector.  The myth of robots actually performing surgery is finally being dispelled. Robotics systems offer a tool for the surgeon to aid in surgical procedures for greater flexibility, precision and control. Patients benefit from improved medical outcomes and faster recovery times.   


From the Field – AI and the black box – who is liable when no one is at fault?

AI is already on its way to transforming healthcare delivery and improving patient outcomes. However, while AI, Machine Learning, and Robotics are all designed to reduce human error and increase the predictability of patient care, they also create new risks across the healthcare liability landscape. In this post, we will consider what happens when lawsuits get ahead of science, insurance considerations in this new liability landscape, and possible modifications to legal doctrine to address this new science.


3D Printing: Transformative Innovation in Healthcare

3D printing medical technologies were introduced in 1984 but the application for innovative healthcare solutions has progressed significantly over the past 3 to 5 years.  Today, advancements are underway to develop sophisticated, individualized healthcare treatments to improve patient outcomes in a broad range of specialty practice areas. Allied Market Research reported that “3D printing technologies for medical devices will be a $2.3 billion industry by 2020.”


IBA Talks Featuring Lainie Dorneker, President, IronHealth

Check out the latest podcast from Insurance Business America featuring Lainie Dorneker, President, IronHealth. Lainie discusses the rapidly evolving healthcare landscape covering trends including consolidation in the healthcare business, the growing presence of technology, consumerism creating a shift towards value-based care, and liability claim trends.


The New Normal in Healthcare Delivery and what it means for customers and insurers | Volume 1

The healthcare industry has been evolving towards a new era focused on precision medicine, value based care, and consumer empowerment. The COVID-19 pandemic may cement these changes well into the future.


The New Normal in Healthcare Delivery and What it Means for Customers and Insurers | Volume 1.1

For years, the government employed traditional methods of combating fraud, waste and abuse. Regulation of Medicaid involved issuing payment to providers for patient services, then later chasing down recoveries on payments deemed improper. On average, this method recovered only 17 percent of improperly billed funds. Slight adjustments to these efforts occurred over time, including the passage of the Health Insurance Portability and Accountability Act (HIPAA) in 1996. HIPAA aimed to combat fraudulent business practices under the traditional fee-for-service healthcare system. Due to numerous revisions, exceptions and interpretations, however, HIPAA has grown convoluted and ineffective.


The New Normal in Healthcare Delivery and What it Means for Customers and Insurers | Volume 1.2:Value-Based Contracting

The healthcare industry is marching toward a new era in which precision medicine and value-based care walk hand in hand with consumer empowerment.


The new normal in life sciences

Prior to 1985, patients relied heavily on their physicians for drug information — especially for data on sourcing and side effects. Direct-to-consumer advertising existed on a limited basis, leaving physicians as the primary recipients of Life Sciences marketing. Physicians had to trust the research, development, and trial testing of the Life Sciences companies. While the Life Sciences industry has always been heavily regulated, most drug testing

at the time occurred in-house as part of the manufacturer’s quality control. If a problem was identified, it was handled by the company, with little public awareness. Moreover, information was not easily accessible, which limited the average consumer’s knowledge of drug sourcing, development, and safety.


Medical Stop Loss Insurance: Helping Health Insurance Corporate Buyers Keep Pace with Medical Inflation

Over the past ten years, healthcare costs have risen steadily each year as treatment and care options have become more sophisticated and advanced. As a result, corporate health insurance buyers are looking for more effective solutions to manage their healthcare spend, which is their biggest cost behind payroll. For employers who chose to self-fund their health insurance programs, employer stop loss insurance protects those groups against large or catastrophic claims, as an alternative to traditional group health insurance and benefits plans. The medical stop loss insurance sector has experienced dramatic growth in recent years as more employers migrate to self-funded health insurance programs, which offer customizable coverage for employees with disciplined cost containment oversight.