Healthcare Reform Blog

Jane DuboseContributor: Jane Dubose
Topic: pharmacy benefits, copay coupons

Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business (the coupons are not allowed for Medicaid and Medicare). Now, it appears the limb broke, and the company has essentially decided to backtrack. Read more.
Posted on: 4/15/2014 1:50:00 PM


Jane DuboseContributor: Jane Dubose
Topic: Copay coupons, pharma benefits, exchanges

Let’s imagine two cars speeding toward one another – in one car are branded manufacturers keen on protecting valuable drug franchises, and on the other are payers equally keen on tamping down drug costs, particularly on new specialty medications. Read more.
Posted on: 4/10/2014 3:47:50 PM


Lyda PhillipsContributor: Lyda Phillips
Topic: ACA, Massachusetts, healthcare costs, payment reform

The fundamental reasoning underpinning the Affordable Care Act is that having fewer uninsured people will ultimately lower healthcare costs for everyone. After all, those uninsured folks won’t be out there racking up medical claims that are eventually covered by everyone with insurance.

Read more.
Posted on: 4/10/2014 1:52:36 PM


Jenny Kerr

Contributor: Jenny Kerr
Topic: CalPERS, Health Net, Sharp Health Plan, UnitedHealthcare, Blue Shield of California, Kaiser Permanente, Covered California, San Francisco Health Service System

The California Public Employees’ Retirement System, the nation’s second-largest purchaser of healthcare services, gambled that more competition among health plans offered to its members would mean cost savings—and it won.

Read more.
Posted on: 4/3/2014 12:48:00 PM


Bill MelvilleContributor: Bill Melville
Topics: Exchanges, ACA, Healthcare.gov, WellPoint

The end of open enrollment for public health exchanges brought sweeping, rapid change. Even in late March, the 7 million enrollees once predicted by the Congressional Budget Office seemed like a pipe dream, and the Obama administration had set lower expectations. After February enrollment brought the tally to just 4.2 million enrollees, the more modest goal of 6 million became a longer shot.

Read more.
Posted on: 4/2/2014 4:09:19 PM


Bill MelvilleContributor: Bill Melville
Topics: ACA, exchanges, navigators, exchange outreach

Even today, the biggest surprise among health exchanges sounds out of place among states with the highest enrollment—California, Florida, Texas, New York, and (drumroll) North Carolina.

Read more.
Posted on: 3/28/2014 1:19:30 PM | with 1 comments


Deborah WhiteContributor: Deborah White
Topics: Accountable care organizations

ACO formation is on fire in Northern New Jersey. In the first half of March alone, three new accountable care organizations have popped up in the 14-county Northern New Jersey healthcare market, bringing the region’s total number of ACO contracts to 27. 

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Posted on: 3/25/2014 9:39:35 AM


Lyda PhillipsContributor: Lyda Phillips
Topic: Hospitals, Mergers

The Boston healthcare market is consolidating so rapidly it resembles a game of musical chairs. No health system in this large and lucrative market wants to be the last one standing, without partners, without affiliations, without the vital referral patterns that keep their flagship urban teaching hospitals’ beds filled. Nailing down these critical relationships will cushion the impact of shared risk as global payment contracting takes over as the dominant model in Massachusetts.

Read more.
Posted on: 3/21/2014 11:48:48 AM


Jenny Kerr

Contributor: Jenny Kerr
Topic: Proton Therapy Centers

In recent years, health systems have turned to development of high-dollar cancer treatment centers to build brand identity as first-rate research facilities and to capture a larger portion of a lucrative market. But the realities of a payer system in transition are forcing health systems to rethink that strategy and could force a move to collaborative efforts with competitors. Insurers are starting to question the effectiveness of the treatment given the associated high cost.

Read more.
Posted on: 3/19/2014 3:32:27 PM


Bill MelvilleContributor: Bill Melville
Topics: Medicaid, Exchange Innovation

When the state of Arkansas broached its private model for Medicaid expansion, it held up as a potential roadmap for partnerships between states hesitant to expand their Medicaid programs. But the second-state to follow that course, Iowa, is emerging as the bellwether for market innovation.

Read more.
Posted on: 3/17/2014 11:25:41 AM


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