Healthcare Reform Blog

Lyda PhillipsContributor: Lyda Phillips
Topic: PBMI, value-based benefit design, prior authorization, Partners HealthCare

The latest Pharmacy Benefit Management Institute survey of trends in pharmacy cost management confirms many anecdotal observations, such as steadily rising cost sharing in employment-based health insurance, higher and higher tiers for prescription drug formularies, and the push to 90-day refills.
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Posted on: 2/13/2015 10:31:21 AM

Ric GrossContributor: Ric Gross
Topics: Medicaid expansion, Indiana, Montana, Tennessee, Utah, Wyoming, health accounts

While it may be true that you can't always get what you want, sometimes you can get pretty darn close. Just ask Indiana Republican Gov. Mike Pence. In May 2014, the potential GOP presidential candidate requested an ambitious Medicaid expansion waiver that would rely heavily on conservative-friendly ideals, such as dedicated health accounts, personal responsibility and a strict plan for member noncompliance.

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Posted on: 2/2/2015 11:42:31 AM

Bill MelvilleContributor: Bill Melville
Topics: CoOportunity Health, Wellmark Blue Cross Blue Shield, Maine Community Health Options, Community, Health Alliance, Kentucky Health Cooperative, New Mexico Health Connections, Blue Cross and Blue Shield of Tennessee

The first major casualty among the new non-profit health plans created by the Affordable Care Act was both swift and surprising.

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Posted on: 1/29/2015 9:51:51 AM

Bill MelvilleContributor: Bill Melville
Topics: Connect for Health Colorado, Access Health CT, Kynect, Covered California, Kaiser Permanente, Blue Shield of California, Florida Blue, Blue Cross and Blue Shield of Texas, Humana, CVS Pharmacy

Increasingly consumers go online for holiday shopping, skipping brick-and-mortar stores and shopping malls. During health exchange open enrollment, health insurers and some state-based exchanges are trending in the opposite direction, increasingly testing retail stores as an enrollment alternative.

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Posted on: 12/15/2014 1:57:36 PM

Bill MelvilleContributor: Bill Melville
Topics: Meritus, Health Choice Arizona, University of Arizona Health Plans, Health Net of Arizona, Connect for Health, Colorado HealthOp, Kaiser Permanente, Humana, Mountain Health Cooperative

The news that some exchange carriers will offer lower premiums in 2015 was a surprise in many markets. But the biggest surprise could await exchange customers who stick with their existing exchange plan without shopping around.
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Posted on: 11/24/2014 12:58:53 PM

April Wortham CollinsContributor: April Wortham Collins
Topics: Affordable Care Act, U.S. Supreme Court, health insurance exchange, insurance tax credits, King vs. Burwell

As health insurance exchange enrollment enters Round Two, a cloud of uncertainty is once again forming over the Affordable Care Act. Earlier this month, the U.S. Supreme Court agreed to hear King vs. Burwell, the latest in a string of legal challenges aimed at the controversial law.
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Posted on: 11/18/2014 3:12:59 PM

Merk CherryContributor: Mark Cherry
Topics: Highmark, Blue plans, M&A, BCBS of Minnesota, Florida Blue

Opponents of Obamacare were delivered fresh fodder when Florida Blue announced plans to raise 2015 exchange premiums by 17.6 percent. But instead of being a direct result of the Affordable Care Act, the Blue plan’s increase may have been caused by one of several efforts by the state legislature to undermine the law. Read more.
Posted on: 11/14/2014 5:04:55 PM | with 1 comments

Chris SilvaContributor: Chris Silva
Topics: Centers for Medicare. Medicaid Services, America’s Health Insurance Plans

As the Medicare ACO program enters its fourth year and Part D celebrates its ninth year, the Centers for Medicare & Medicaid Services is investigating ways to marry the two programs to bring coordinated care and the concept of shared savings to Medicare drug benefits. Read more.
Posted on: 11/14/2014 12:04:13 PM

Jenny Kerr

Contributor: Jenny Kerr
Topic: Anthem Blue Cross, Kaiser Permanente, CalPERS, Arizona Health Network, Dignity Health, Abrazo Health, MemorialCare

Maybe it’s a matter of scale. Accountable care organizations in many markets are looking to grow, in some cases expanding to include multiple unaffiliated hospitals and health systems. The question is whether an ACO can be too big and whether competitors in every other aspect except an ACO agreement can effectively coordinate care?

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Posted on: 11/6/2014 9:47:46 AM

April Wortham CollinsContributor: April Wortham Collins
Topics: Health information technology, electronic health records, Office of the National Coordinator for Health Information Technology, HITECH Act, meaningful use, interoperability

Accountable care organizations in Texas were responsible for a large cut of the dollars saved by the Medicare Shared Savings Program thus far. Not all Texas ACOs saved money, but the ones that did indicate that accountable care could have staying power in unexpected places.
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Posted on: 10/30/2014 2:53:17 PM

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