Healthcare Reform Blog

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.
Read more.
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.

Read more.
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.

Read more.
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.

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


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