Healthcare Reform Blog

Fresh U.S. healthcare insights from expert analysts on Healthcare Reform, ACOs, Exchanges, Medicaid, Medicare, regional and national trends…and much more
Contributor: Sarah Wilson
Topics: Mergers & Acquisitions, Health Insurance, Medicare, UnitedHealth Group, Aetna, Anthem, Cigna, Humana

For years, there has been the “Big Five” of health insurance companies, but a change to the “Big Three” of Anthem-Cigna, UnitedHealth Group, and Aetna-Humana appears to be closer to reality. The idea that Aetna would acquire Humana or that Anthem would acquire Cigna seemed a more remote possibility earlier this year. Read more.
Posted on: 7/24/2015 2:07:26 PM


Bill MelvilleContributor: Bill Melville
Topics: Anthem, Cigna

With the long-awaited merger of giants Anthem and Cigna announced, the impact on the newest market segment in health insurance might could be significant.


Read more.
Posted on: 7/24/2015 2:04:27 PM


Contributor: Evan Camden
Topics: Medicaid expansion, ACA, reimbursements, healthcare access

Imagine, for the first time in your life, you are able to sign up for Netflix and have access to the movies you want, when you want them. You sign up, pay your monthly dues, then go to stream the movie you want, only to find out you don’t have access through Netflix. Hulu has the movie available, but your subscription doesn’t work with that service. Another option is to buy the movie, but that will cost a considerable amount more than you want to pay, which is why you signed up for Nexflix in the first place. If you can’t get the movie you want, when you want it, through your Netflix account, what is the point of having it? Read more.
Posted on: 7/21/2015 11:37:53 AM


Lyda PhillipsContributor: Lyda Phillips
Topics: Aetna, Catamaran, consolidation, CVS/caremark, EnvisionRx, Express Scripts, Humana, M&A, OptumRx, PBM

The year 2015 was in its infancy when a PBM executive remarked to a Decision Resources Group colleague, “You can expect more consolidation this year.”

Boy, was he right. Read more.
Posted on: 7/17/2015 4:54:56 PM


Contributor: Sydney Hester
Topics: ACA, Exchanges, Healthcare Reform, Mergers, Aetna, Humana, UnitedHealth Group

As the King vs. Burwell ruling set the ACA exchanges in stone and news of potential payer consolidations hit the media, the individual insurance market looks to be center stage for the foreseeable future. Analysis by DRG’s data team shows the rapidly growing individual market has become a competitive hotspot, where the top five payers offering individual HIX plans have secured over 30 percent of the market. Read more.
Posted on: 7/17/2015 9:23:59 AM


April WorthamContributor: April Wortham Collins
Topics: ACO, Medicare, Shared Savings

Earlier this summer, the Centers for Medicare & Medicaid Services released a final rule that updates provisions of the Medicare Shared Savings Program, the nation’s largest accountable care organization experiment involving more than 400 ACOs serving some 7 million Medicare beneficiaries. Read more.
Posted on: 7/15/2015 9:36:29 AM


Jane DuboseContributor: Jane DuBose
Topics: Aetna, Anthem, consolidation, Humana, M&A, Medicare, UnitedHealth

Expect the proposed Aetna/Humana merger to be a full employment act for antitrust lawyers over the next few months. Multiple states, as well as the federal Department of Justice, are looking into whether the mammoth merger would create unfair competition in certain markets. Read more.
Posted on: 7/15/2015 9:19:04 AM


Bill MelvilleContributor: Bill Melville
Topics: Access Health CT, King v. Burwell, Affordable Care Act, Kentucky Health Cooperative, Healthcare.gov, Community Health Alliance, CoOportunity Health, Kynect

Subsidies in federally run health exchange will live to see another open enrollment.

In an opinion penned by Chief Justice John Roberts, the Supreme Court ruled 6-3 that the Affordable Care Act’s authors clearly intended to extend subsidies to people buying coverage through federally facilitated and state-run health exchanges. Read more.
Posted on: 6/25/2015 12:10:53 PM


paula-wade-81x99.jpgContributor: Paula Wade
Topics: Anthem, BCBS, Blue Card, Cigna, consolidation, M&A

Anthem’s June 20 proposal to purchase Cigna Corp. has stumbled in part because of one big unknown: how the deal would hold up against the licensing rules of the Blue Cross and Blue Shield Association, which controls utilization of the Blue brand by all BCBS carriers, including Anthem’s 14 Blue subsidiaries. Read more.
Posted on: 6/22/2015 3:24:43 PM


deborah-white-81x99.jpgContributor: Deborah White
Topics: Barnabas Health, consolidation, Hackensack University Health Network, Horizon BCBS, M&A, Meridian Health System, New Jersey, Robert Wood Johnson Health System

So many hospitals deals are in the works in northern New Jersey that I use an ever-changing scorecard to keep track of them. A dozen deals are active at any given time, including mergers, acquisitions, affiliations, and partnerships. Read more.
Posted on: 6/19/2015 2:33:47 PM


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