Healthcare Reform Blog

Merk CherryContributor: Mark Cherry
Topics: Hospitals, Consolidation, ACA, Narrow Networks

Like in Fantasy Football, Fantasy Health System is about matchups. But instead of racking up passing yards against a weak secondary, or sacks against a weak O-line, a Fantasy Health System must garner a sufficient number of hospitals and physicians in order to influence its reimbursement rate from payers.
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Posted on: 9/26/2013 3:59:38 AM


Jane DuboseContributor: Jane Dubose
Topic: ACA, Exchanges, MCOs, HHS

After more than three years of legal challenges, political grandstanding, rulemaking and technology building, it’s almost show time for the public health benefits exchanges. In a matter of days, Americans will get their first look under the hood of one of the largest new programs ever undertaken by federal and state governments.

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Posted on: 9/25/2013 1:25:24 PM


Bill MelvilleContributor: Bill Melville
Topics: Healthcare reform, Medicaid, exchanges, Kentucky

As the tremors of health reform grow more forceful every day, their epicenter can be hard to pinpoint. Every state has approached the law differently, from Maryland moving ahead on a health exchange in March 2010 to numerous states refusing any role in implementation. Can a single state serve as an indicator for ACA success?

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Posted on: 9/12/2013 3:35:34 PM


Lyda PhillipsContributor: Paula Wade
Topic: Exchanges, MCOs, ACA

If you want to understand the profit potential of the Affordable Care Act - without the obscurant of any political lens – just follow the money. Look at what the publicly held insurers – cold-eyed healthcare capitalists all - are doing relative to the state healthcare exchanges, for example. Are they lining up to participate, or running away?

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Posted on: 9/4/2013 1:17:35 PM


Ric GrossContributor: Ric Gross
Topic: Medicaid expansion, Medicaid MCOs, New Hampshire

At times throughout the past year, following New Hampshire’s Medicaid efforts has been somewhat like watching a mouse on an exercise wheel. A lot of activity but not really getting anywhere.
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Posted on: 8/28/2013 2:34:23 PM


Bill MelvilleContributor: Bill Melville
Topics: Exchanges, ACA

For most of its brief existence, the Washington Health Plan Finder looked like a model state-run exchange. Nine carriers representing a good mix of commercial and Medicaid players filed to sell policies. The state moved quickly to build its exchange infrastructure and chose to operate as an active purchaser, requiring insurers to bid on exchange business.

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Posted on: 8/26/2013 1:00:56 PM


Jenny Kerr

Contributor: Jenny Kerr
Topic: ACOs, Pioneer, ACA

At least one Pioneer ACO in California has saved money from Medicare’s ambitious accountable care experiment. San Francisco’s Brown & Toland, an independent physician practice with about 1,500 physicians, reported savings of $10.6 million in 2012. About 190 physicians treated 18,000 Medicare patients in the Pioneer ACO, and generated savings by coordinating care and avoiding unnecessary hospitalizations, the group said.

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Posted on: 8/13/2013 4:23:27 PM


Chris LewisContributor: Chris Lewis
Topics: Small-group exchanges, SHOP, exchanges, healthcare reform, Anthem

Anthem Blue Cross’s absence from the California small-business health insurance exchange is curious on many levels. Why would one of the state’s biggest small-group insurers shun a ready-made source of business, with the muscle of a massive federally funded marketing campaign behind it?
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Posted on: 8/8/2013 3:47:29 PM


Bill MelvilleContributor: Bill Melville
Topics: ACA, Exchanges, MCOs

Call it a case of diminished expectations: UnitedHealthcare initially planned to participate in up to 25 state marketplaces. With each successive quarterly earnings call, however, the carrier’s planned exchange profile seemed to fade. Now, you can count exchanges where UnitedHealth has applied with two hands. The carrier could still play in 10-12 exchanges, but it is being extremely picky.
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Posted on: 7/25/2013 11:43:12 AM


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.

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Posted on: 7/24/2013 11:37:20 AM


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