Healthcare Reform Blog

Lyda PhillipsContributor: 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.

Read more.
Posted on: 2/21/2014 3:07:42 PM | with 1 comments


Chris LewisContributor: Chris Lewis
Topics: Exchanges, ACA, health plans

Extending cancelled individual insurance policies for another year may seem appropriate for states where the federal government has taken over and “fumbled” on exchanges, but states ahead of the game are put in an unfair bind by President Obama’s about-face on the Affordable Care Act.

Read more.
Posted on: 11/19/2013 8:34:02 PM


AnnJeanette Colwell

Contributor: AnnJeanette Colwell
Topic: Health plans, managed care, ACA

The Affordable Care Act was touted as a way to increase competition among insurers in order to drive down costs for consumers, as well as provide an opportunity for small to mid-size carriers to expand their business. However, the recent exit of a strong regional plan from most of its markets indicates that the ACA could be having the opposite effect.

Read more.
Posted on: 7/24/2013 11:37:20 AM


Bill MelvilleContributor: Bill Melville
Topic: Health exchanges, health plans, ACA

Every time a health plan reveals its health exchange strategy, the market winces. The same holds true when health exchanges pulling back the curtain on participating plans.

Read more.
Posted on: 5/8/2013 1:57:48 PM


Carolyn McMeekinContributor: Carolyn McMeekin
Topic: ACA, medical devices, health plans, hospital systems

If you felt a shudder last week, it may have been the collective medical device industry imagining its future now that UnitedHealth Group and some large health systems have banded together to conduct independent studies on the long-term effectiveness of some medical devices.

Read more.
Posted on: 4/17/2013 4:16:20 PM


Contributor: Sarah Wilson
Topic: M&A, ACA, hospitals, physician groups, health plans

When the ball dropped on New Year’s Eve, it ushered in more than the annual, half-hearted decision to diet and exercise… starting bright and early the next morning. Jan. 1 also rang in a renewed resolve by healthcare firms to consolidate, continuing a trend accelerated by healthcare reform. Health systems, physician groups, health plans, and other industry members have examined and implemented every possible consolidation model as a way to prepare for the upcoming changes facing the industry come Jan. 1, 2014.
Read more.
Posted on: 1/11/2013 5:02:32 PM


Contributor: Jenny Kerr
Topic: ACOs, hospitals, health plans, physicians

At the Third National ACO Congress in Los Angeles last month, it was clear that all players in the three-legged stool of hospitals, health plans and physicians see ACOs as the future of reshaping healthcare cost and delivery. However, hospitals remain the biggest holdout in the evolution to population-based care that pays providers based on quality and outcomes instead of by service.

Read more.
Posted on: 11/27/2012 9:06:22 AM


Contributor: Jane DuBose
Topic: Provider Reimbursement, Care Coordination, Medical Homes

In a signal that care-coordination has gone well beyond lip service, there was news last week that the American Medical Association is adding new codes to its 2013 Bible on provider reimbursement. The book, 2013 CPT Professional Edition, is the essential link between providers’ office activity and the payments they receive from insurers.
Read more.
Posted on: 8/27/2012 4:02:25 PM


Contributor: Jane DuBose
Topic: Healthcare reform, Rebates, Medical Loss Ratio

While Wall Street has focused on the obvious pick-ups in Medicare and Medicaid business that Aetna’s purchase of Coventry Health Care will generate, there may also be gems in the commercial treasure chest that Coventry opens to its bigger rival.
Read more.
Posted on: 8/20/2012 4:24:53 PM


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.

Read more.
Posted on: 2/3/2012 2:21:51 PM


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Chris LewisContributor: Chris Lewis
Topics: Employers, ACA, Cadillac Tax, consumer-driven health plans, member engagement

Listening to the nation’s largest employers share their anxieties and strategies over the rising cost of healthcare at the National Business Group on Health conference would be a sobering experience for any healthcare consumer. By the next decade, many of us are going to be enrolled in health plans that demand us to carefully scrutinize every decision we make and each dollar we spend. More of us will be responsible for up to $6,000 in out-of-pocket costs before real coverage kicks in.

Read more.
Posted on: 3/13/2014 2:59:25 PM


Lyda PhillipsContributor: 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.

Read more.
Posted on: 2/21/2014 3:07:42 PM | with 1 comments


Bill MelvilleContributor: Bill Melville
Topics: 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.

Read more.
Posted on: 1/9/2014 7:49:22 PM


Chris LewisContributor: Chris Lewis
Topics: Exchanges, ACA, health plans

Extending cancelled individual insurance policies for another year may seem appropriate for states where the federal government has taken over and “fumbled” on exchanges, but states ahead of the game are put in an unfair bind by President Obama’s about-face on the Affordable Care Act.

Read more.
Posted on: 11/19/2013 8:34:02 PM


AnnJeanette Colwell

Contributor: AnnJeanette Colwell
Topic: Health plans, managed care, ACA

The Affordable Care Act was touted as a way to increase competition among insurers in order to drive down costs for consumers, as well as provide an opportunity for small to mid-size carriers to expand their business. However, the recent exit of a strong regional plan from most of its markets indicates that the ACA could be having the opposite effect.

Read more.
Posted on: 7/24/2013 11:37:20 AM


Bill MelvilleContributor: Bill Melville
Topic: Health exchanges, health plans, ACA

Every time a health plan reveals its health exchange strategy, the market winces. The same holds true when health exchanges pulling back the curtain on participating plans.

Read more.
Posted on: 5/8/2013 1:57:48 PM


Carolyn McMeekinContributor: Carolyn McMeekin
Topic: ACA, medical devices, health plans, hospital systems

If you felt a shudder last week, it may have been the collective medical device industry imagining its future now that UnitedHealth Group and some large health systems have banded together to conduct independent studies on the long-term effectiveness of some medical devices.

Read more.
Posted on: 4/17/2013 4:16:20 PM


Contributor: Sarah Wilson
Topic: M&A, ACA, hospitals, physician groups, health plans

When the ball dropped on New Year’s Eve, it ushered in more than the annual, half-hearted decision to diet and exercise… starting bright and early the next morning. Jan. 1 also rang in a renewed resolve by healthcare firms to consolidate, continuing a trend accelerated by healthcare reform. Health systems, physician groups, health plans, and other industry members have examined and implemented every possible consolidation model as a way to prepare for the upcoming changes facing the industry come Jan. 1, 2014.
Read more.
Posted on: 1/11/2013 5:02:32 PM


Contributor: Jenny Kerr
Topic: ACOs, hospitals, health plans, physicians

At the Third National ACO Congress in Los Angeles last month, it was clear that all players in the three-legged stool of hospitals, health plans and physicians see ACOs as the future of reshaping healthcare cost and delivery. However, hospitals remain the biggest holdout in the evolution to population-based care that pays providers based on quality and outcomes instead of by service.

Read more.
Posted on: 11/27/2012 9:06:22 AM


Contributor: Jane DuBose
Topic: Provider Reimbursement, Care Coordination, Medical Homes

In a signal that care-coordination has gone well beyond lip service, there was news last week that the American Medical Association is adding new codes to its 2013 Bible on provider reimbursement. The book, 2013 CPT Professional Edition, is the essential link between providers’ office activity and the payments they receive from insurers.
Read more.
Posted on: 8/27/2012 4:02:25 PM


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