Contributor: Chris Clancy
Topic: Pharmacy benefits, P&T committees, value-based formularies

When it comes to assessing the clinical benefits of a drug and deciding on which tier that drug is placed, the conversation traditionally begins and ends with a plan’s Pharmacy and Therapeutics Committee. However, now that Premera Blue Cross in Washington has seen its value-based formulary implemented by a couple of large, healthcare-related employers in the Puget Sound area, a new avenue of cost savings may exist for insurers wanting more bang for their drug-purchasing buck.

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Contributors: Laura Beerman and Ed Park
Topic: ACOs, hospitals, medical devices, healthcare reform

A recent survey by consultants L.E.K. of more than 200 hospital executives paints the picture: the next five years will likely see spending decreases for large device med tech spending. With 80 percent of those respondents already members of or planning to join accountable care organizations, there are three things med tech should put on its radar.

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Contributor: Bill Melville
Topic: Health exchanges, health plans, ACA

Every time a health plan reveals its health exchange strategy, the market winces. The same holds true when health exchanges pulling back the curtain on participating plans.

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Contributor: Sarah Wilson
Topic: M&A, ACA, health systems

Nordstrom, Facebook, Starbucks and Google are considered to be some of the best companies to work for, in no small part due to their company cultures. From a healthcare standpoint, Cleveland Clinic is thought to have one of the best cultures, or unique practices separating it from others. There is a great emphasis placed on a company’s ability to establish and maintain a successful culture. However, this can be challenging when organizations undergo consolidation.
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Contributor: Chris Lewis
Topics: ACA, CalPERS, state employee benefits

As health reform starts in earnest in 2014, health plans in California will not only be jockeying for insurance exchange members but also for the business of state employees and retirees.

In a decision that could significantly alter commercial insurance market share over the next five years, the California Public Employees Retirement System—with a total of 1.3 million members—has opened up the statewide HMO business to four other carriers, dependent upon their ability to successfully negotiate contracts with the agency, a process now underway.

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Contributor: Carolyn McMeekin
Topic: ACA, medical devices, health plans, hospital systems

If you felt a shudder last week, it may have been the collective medical device industry imagining its future now that UnitedHealth Group and some large health systems have banded together to conduct independent studies on the long-term effectiveness of some medical devices.

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Contributor: Mark Cherry
Topic: ACA, Medicaid, Exchanges

 While Gov. Rick Scott and the Florida Senate have put forward Medicaid expansion plans that attempt to cover 1 million uninsured residents through private insurance, Florida House Republicans responded with Florida Health Choices Plus—not so much a proposal for reducing the state’s high uninsured rate, but rather a 46-page treatise on why private insurance is better than Medicaid.

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Guest Blogger: John Jaeger VP of PharmaStrat
Topic: ACOs, ACA

Since March 2010, my colleagues and I have burned a lot of calories discussing the Patient Protection and Affordability Care Act (ACA) and all the many ways that it can impact healthcare, particularly with those organizations that are responsible for touching the 3 P’s (patients, physicians, and payers). I remember speaking about the complexity of the legislation and uncertainties that it created in the market access and reimbursement landscape with a biopharmaceutical client the day after the bill was signed and he said, “The good news is that we have plenty of time to sort it all out.” That may have been true then, but there sure seems to be a lot of sorting still left to be done.

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Contributor: Sheri Sellmeyer
Topic: Exchanges, Germany, utilization

A psychiatrist (and friend) from Germany responded to one of our recent blogs about the healthcare exchanges set to launch in 2014. He found it bizarre that Americans without health insurance will have to pay a small penalty, which will go up over time.

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Contributer: Joel Peyton
Topic: Medicare, ACA, SGR

In February, the Centers for Medicare & Medicaid Services released the Advance Notice Call Letter, which outlined proposed changes to the Medicare Advantage program in 2014. One of the most controversial components of the letter was that CMS planned to cut reimbursement rates to MA plans by 2.2 percent. News of the proposed cut caused an outcry from lobbyists, politicians, and seniors. Some predicted that if the cuts happened, seniors could see up to $90 per month in premium increases and/or benefit reductions.
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