Contributor: April Wortham
Topic: Accountable care organizations

Even as accountable care organizations sprout up around the country, plenty of questions remain. What will ACOs look like? Who will manage them? How much cost savings, if any, will they produce? Perhaps the only thing about ACOs that everybody can agree on is they must be provider-driven.

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Contributer: Paula Wade
Topic: Primary care reimbursement

It was inevitable, really: insurance giant WellPoint has announced it will raise rates for primary-care providers by 10 percent and add a reimbursement code so that doctors can be paid for creating and maintaining care plans for their patients with chronic disease. Just the first step, we’re told, in a new contracting-for-care-management strategy that hopes to transition large numbers of PCPs to do medical home-style care coordination for certain types of patients.

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Contributor: Laura Beerman
Topic: Health plans

On Jan. 12, 2012, Stephen Colbert of Comedy Central’s The Colbert Report announced his possible candidacy for the presidency in South Carolina. But first, he had to do one very important thing: transfer control of his super PAC to Jon Stewart.
Perhaps he was taking a page out of UnitedHealth Group’s playbook.

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Contributer: Joel Peyton
Topic: Medicare

Here’s a question for Medicare: When will the Centers for Medicare and Medicaid Services (CMS) throw away the old hammer and chisel of fee for service and exchange them for some of the modern tools that most Medicare Advantage (MA) plans have been using for years to improve the health of the chronically ill?
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Contributer: Paula Wade
Topic: Aetna

Other than giving the folks in the Marketing Department something to do, “re-branding” is generally a fairly shallow cosmetic exercise at most businesses. But Aetna’s recent makeover of its logo attends a real transformation in the company’s business, shaped by healthcare reform and market forces and, perhaps, the uncertainty around healthcare’s future.

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Contributer: Ric Gross
Topic: ACOs

When Massachusetts passed its near-universal healthcare reform law in 2006, the state found itself in the center of the healthcare spotlight. In fact, as the law initially received positive reviews, those who helped craft the legislation were treated as a form of rock stars—healthcare versions of Bruce Springsteen, if you will.
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Contributer: Jane DuBose
Topic: Medicare

The past week might be one that Republican presidential candidates and the designers of CMS pilot programs will want to forget. Disappointing results. Funny numbers. The need for better PR. And that’s just Mitt Romney.
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Contributor: Laura Beerman
Topic: Pharmacists

When more people have access to healthcare coverage in 2014, the existing shortage of physicians could make a good doctor even harder to find. Waiting in the wings are other practitioners—including pharmacists—who can provide effective, patient-centered care.

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Contributer: Joel Peyton
Topic: Medicare star ratings

New star ratings metrics that measure both Medicare Advantage plans and Part D prescription drug plan performance could prove difficult for some stand-alone prescription drug plans. While PDP plans do not receive reimbursement bonuses based on overall performance, they do face scrutiny from the Centers for Medicare & Medicaid Services if plans score less than 3 stars for three years in a row.

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Contributer: Sheri Sellmeyer
Topic: Pharma and social media

The days when pharma reps could discuss off-label uses of their companies’ drugs are a distant memory for some, and no memory at all for younger reps who entered the business after the FDA issued strict regulations on the matter.

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