COE networks currently play an important role in the delivery of care for specialized service lines, including but not limited to solid organ transplantation (SOT), hematopoietic cell transplantation (HCT) and … Read More

In previous Research Briefs, we have discussed challenges faced by payers when contemplating using multiyear performance-based contracts. In this brief, we extend the discussion to include additional difficulties that may … Read More

Spreading payments over time for durable or curative therapies can provide a better alignment between benefits and costs, but creates challenges when patients switch insurance coverage during the contract term. … Read More

An Orphan Reinsurer Benefit Manager (ORBM) could address the financial challenges (payment timing, therapeutic performance risk, actuarial risk), created by durable/potentially curable gene and cell therapies especially for smaller insurers … Read More

The uncertain number of patients likely to be treated with an expensive novel therapy (actuarial risk) could represent a major financial issue for some payers. In this brief, we will … Read More

Designing Precision Financing for cures can be informed by a framework that tailors solutions to the three financing challenges of actuarial risk, performance risk and payment timing based on the … Read More

FoCUS participants have identified four payer segments for precision financing: self-insured employers and related organizations; health insurance plans and managed care organizations; Medicare; and Medicaid. Download FoCUS Research Brief_2018F202-014Share the … Read More

In a broad survey, payers favor performance based milestone contracts and risk pools strategies to absorb the surge of high cost gene therapy products expected to enter the market over … Read More