Healthcare Reform Blog

Contributer: Sheri Sellmeyer
Topics: CO-OPs, EHR

Two days at DRG’s Managed Markets Summit last week made me smarter about many topics, but a couple stand out: CO-OPs in the exchanges and electronic health records.
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Posted on: 3/7/2014 8:37:26 PM


Contributer: Laura Beerman
Topics: ACOs, results, CMS, North Country

New Hampshire has a new claim to fame. Yes, it’s the site of the first primary in a presidential election year. But for us healthcare nerds, it’s now home to one of the first Medicare Shared Savings Program (MSSP) ACOs to publish results for all 33 measures on its website: North Country ACO.
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Posted on: 3/6/2014 1:20:17 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.

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


Merk CherryContributor: Mark Cherry
Topics: BCBS plans, merger, M&A, Highmark, Independence Blue Cross, Blue Cross of Northeastern Pennsylvania, Aetna, Capital Blue Cross

With this week’s announcement of the pending merger between Highmark and Blue Cross of Northeastern Pennsylvania, the next question may be whether Highmark revisits its attempted merger with Independence Blue Cross. The combination of Pittsburgh’s Highmark with IBC of Philadelphia would have created one of the largest nonprofit health insurers in the nation, but the two Blues plans walked away from the deal in 2009 after the state imposed a seemingly innocuous condition: relinquish either the Blue Cross or Blue Shield brand. Read more.
Posted on: 2/19/2014 12:05:38 PM


Jane DuboseContributor: Jane Dubose
Topic: ACOs, Pioneers, CMS

For those ACO watchers who are in the glass-half-empty camp, there was plenty of spilled milk to absorb from the government’s preliminary report on the Medicare Pioneer and Shared Savings Programs released Jan. 30. Read more.
Posted on: 2/6/2014 9:15:39 AM | with 1 comments


Sarah WilsonContributor: Sarah Wilson
Topic: M&A, Consolidation, IDNs

“Frothy” was the buzzword used at a recent conference in Nashville to describe the climate of healthcare mergers and acquisitions in 2014—a fitting description of an industry that continues to bubble with consolidation activity. However, experts who spoke at the iiBig (International Institute for Business Information & Growth) event believe that health systems will begin placing a greater emphasis on “quality” acquisitions as opposed to the “quantity” purchases we’ve seen of late that alter market dynamics.
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Posted on: 2/5/2014 1:44:51 PM


Jacqueline CavnarContributor: Jacqueline Cavnar
Topics: Affordable Care Act, Provider reimbursement, Medicaid

Po-tay-to or po-tah-to? Single payer or social welfare? There is always more than one side to an argument, especially when the debate is about healthcare.

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Posted on: 1/13/2014 2:10:32 PM


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.

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Posted on: 1/9/2014 7:49:22 PM


Lyda PhillipsContributor: Lyda Phillips
Topic: Hospitals, M&A

In its first act, a new Massachusetts oversight commission has fired a shot across the bow of the biggest frigate in Boston harbor: Partners HealthCare System, the prestigious parent of MassGeneral and Brigham and Women’s hospitals.

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Posted on: 12/19/2013 10:23:52 PM


Lyda PhillipsContributor: Paula Wade
Topic: ACA, exchanges, narrow networks, high deductibles, Medicaid expansion, insurance cancellations

The Affordable Care Act is complicated—we all knew that, right? And we’ve all had two-plus years to read it, read about it, talk about it, make rules and plans and whole political campaigns about it.

Yet after all that time, many Americans remain uninformed or misinformed about the ACA and what to expect as it rolls out, and the American news media and the government have not made any great strides in explaining it to the public.

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Posted on: 12/5/2013 6:41:54 PM


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