Healthcare Reform Blog

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.

Read more.
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.

Read more.
Posted on: 12/5/2013 6:41:54 PM


Merk CherryContributor: Mark Cherry
Topics: ACA, Narrow Networks, Star ratings, Medicare Advantage

UnitedHealthcare has been in the habit of making Medicare open enrollment interesting in Tampa Bay. In an effort to make its sprawling Medicare Advantage provider network more cost efficient and controllable, UnitedHealth slashed hospitals and physicians from its AARP Medicare Complete plans for 2014. The move has happened in markets throughout the nation but is attracting a lot of attention on the west coast of Florida, where UnitedHealth is the largest insurer. UnitedHealth will no longer offer in-network coverage at the venerable H. Lee Moffitt Cancer Center, and hundreds of physicians from Tampa Bay to Naples were taken off the MA plan’s in-network roster for 2014. Read more.
Posted on: 12/2/2013 2:03:47 PM


Sheri SellmeyerContributor: Sheri Sellmeyer
Topics: EMR, Copay Coupons, Drug Adherence

With so much focus on the struggling health insurance exchange web sites, other equally important aspects of healthcare reform haven’t been getting much press.

One of those is the push to move physicians into using electronic prescribing and electronic health records. The idea is that e-prescribing flags possible adverse reactions, provides an electronic record, and gives physicians ready access to formularies and how drugs are tiered. The goal of using electronic health records – something we should have accomplished many years ago – is to allow seamless, accurate communication among doctors, hospitals, and patients for all of a patient’s medical records. Read more.
Posted on: 11/25/2013 2:57:01 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


April WorthamContributor: April Wortham
Topics: Health insurance exchanges, ACA

Anyone who has been following closely the development of health insurance exchanges knew that setting Oct. 1 as the launch date for HealthCare.gov was an incredibly ambitious, if not entirely unrealistic, goal. But for an entire month to pass and the site be largely unavailable to millions of Americans? Not even a panel of industry insiders could have predicted that. Read more.
Posted on: 11/11/2013 7:07:56 PM


Sheri SellmeyerContributor: Sheri Sellmeyer
Topics: Exchanges, drug coupons, ACA, copays

A few weeks ago I wrote in this blog that pharmacy coupon copays would likely not be allowed for health benefits sold through the exchanges.

I was wrong. Read more.
Posted on: 11/4/2013 8:42:50 PM


Jane DuboseContributor: Jane Dubose
Topic: Copay coupons, statins, adherence, exchanges

Pharmaceutical manufacturers have scored two recent wins related to their increasing use of discount coupons for branded drugs.
First, they will be allowed to offer the coupons to those enrolling in the new marketplaces. Second, a new study is one of the first to link coupon use to higher drug adherence, in this case, for patients using statins. Read more.
Posted on: 11/4/2013 3:48:29 PM


Merk CherryContributor: Mark Cherry
Topics: Mini-Meds, ACA, Exchanges, Individual Insurance

When President Obama first started using the line about "if you like your insurance plan, you can keep it," he may not have anticipated how many defenders there would be of the reviled mini-med policy. Read more.
Posted on: 10/31/2013 12:05:40 PM


Laura BeermanContributor: Laura Beerman
Topics: ACOs, Orphan Diseases, MMS

It’s been a month since DRG’s Managed Markets Summit, but there’s a conversation I can’t forget: if and when ACOs will affect the rare/orphan drug landscape.

The question was posed by a conference attendee between sessions. As my new friend and I talked through pulmonary hypertension and the rather busy market space for such a rare condition, my short answer was that the immediate impact of ACOs on companies like his would be a longer time coming. And that the effect was likely to be more indirect than direct. Why? Read more.
Posted on: 10/28/2013 9:39:58 AM


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