Contributor: Mark Cherry
Topics: Narrow networks, ACA, M&A
For health systems that enjoy a dominant market share within their region and have a clinically integrated physician organization, the choice going forward is relatively clear: develop your own narrow-network health plan, either on your own or with a partner MCO. But second-place health systems, particularly in mid-major markets, are reaching a crossroads, with the choices of: merging with a nonprofit health system, being acquired by a for-profit hospital chain, or affiliating more closely with a major health plan. Read more.
Posted on: 3/11/2014 9:46:06 AM
Medicaid, ACA, Exchanges
Drama. Intensity. Emotions reaching a boiling point. Characters with murky motives. Debates about how things are going to end. While this sounds like a description of HBO’s hit television drama “True Detective,” it also aptly describes the Medicaid expansion debate still raging across multiple states. “True Medicaid”? Not sure if that’s a TV show anyone wants to air, but it certainly is not lacking for lead characters.
Posted on: 3/10/2014 4:40:44 PM
Two days at DRG’s Managed Markets Summit last week made me smarter about many topics, but a couple stand out: CO-OPs in the exchanges and electronic health records.
Posted on: 3/7/2014 8:37:26 PM
ACOs, results, CMS, North Country
New Hampshire has a new claim to fame. Yes, it’s the site of the first primary in a presidential election year. But for us healthcare nerds, it’s now home to one of the first Medicare Shared Savings Program (MSSP) ACOs to publish results for all 33 measures on its website: North Country ACO.
Posted on: 3/6/2014 1:20:17 PM
Contributor: Paula Wade
Topic: Health plans, earnings, ACA, exchanges, Aetna, Cigna, Humana, UnitedHealth, Molina, WellCare, Centene, employers
The famous advice from “Deep Throat” to Bob Woodward and Carl Bernstein still holds true: if you want to know what’s going on, always follow the money.
And there are always insights to be gained from the quarterly earnings calls that the publicly traded health plans hold with Wall Street investment analysts. While the discussions are centered around financials, there is generally some good “color” about how the industry and segments are doing.
Posted on: 2/21/2014 3:07:42 PM
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Contributor: Mark Cherry
Topics: BCBS plans, merger, M&A, Highmark, Independence Blue Cross, Blue Cross of Northeastern Pennsylvania, Aetna, Capital Blue Cross
With this week’s announcement of the pending merger between Highmark and Blue Cross of Northeastern Pennsylvania, the next question may be whether Highmark revisits its attempted merger with Independence Blue Cross. The combination of Pittsburgh’s Highmark with IBC of Philadelphia would have created one of the largest nonprofit health insurers in the nation, but the two Blues plans walked away from the deal in 2009 after the state imposed a seemingly innocuous condition: relinquish either the Blue Cross or Blue Shield brand. Read more.
Posted on: 2/19/2014 5:05:38 PM
ACOs, Pioneers, CMS
For those ACO watchers who are in the glass-half-empty camp, there was plenty of spilled milk to absorb from the government’s preliminary report on the Medicare Pioneer and Shared Savings Programs released Jan. 30. Read more.
Posted on: 2/6/2014 2:15:39 PM
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M&A, Consolidation, IDNs
“Frothy” was the buzzword used at a recent conference in Nashville to describe the climate of healthcare mergers and acquisitions in 2014—a fitting description of an industry that continues to bubble with consolidation activity. However, experts who spoke at the iiBig (International Institute for Business Information & Growth) event believe that health systems will begin placing a greater emphasis on “quality” acquisitions as opposed to the “quantity” purchases we’ve seen of late that alter market dynamics.
Posted on: 2/5/2014 1:44:51 PM
Affordable Care Act, Provider reimbursement, Medicaid
Po-tay-to or po-tah-to? Single payer or social welfare? There is always more than one side to an argument, especially when the debate is about healthcare.
Posted on: 1/13/2014 2:10:32 PM
Consumer operated and oriented plans, CO-OPs, Affordable Care Act, Health insurance exchange, Provider network, CoOportunity Health, Montana Health CO-OP, Minuteman Health
Since being enabled by the Affordable Care Act, Consumer Operated and Oriented Plans have felt like dead men walking to the gallows and nearly everyone following health reform has been ready to write their epitaph.
Posted on: 1/9/2014 7:49:22 PM