Healthcare Reform Blog

Fresh U.S. healthcare insights from expert analysts on Healthcare Reform, ACOs, Exchanges, Medicaid, Medicare, regional and national trends…and much more
Bill MelvilleContributor: Bill Melville
Topics: exchanges, Washington, premiums

Forget about taking a deep, relaxing breath at the end of 2014’s open enrollment in the exchanges. Before anything from 2014 has settled, 2015 is already knocking at the front door.
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Posted on: 5/28/2014 10:28:57 AM


Chris LewisContributor: Chris Lewis
Topics: Sovaldi, hepatitis C, Gilead, Olysio

You know a pill is powerful when it brings the nation’s healthcare leaders into one room to debate its broad implications for U.S. health policy.

The lightning rod is Sovaldi, the new hepatitis C wonder drug that, at $1,000 a pill, has every payer in the country quaking in its boots about how to pay for it.

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Posted on: 5/27/2014 9:19:55 AM


Chris LewisContributor: Chris Lewis
Topics: asthma, exchanges, formularies

With 2014 approaching the halfway mark, health plans are already turning their attention to next year’s qualified health plans—and that means determining drug formularies for 2015. Payers’ continual challenge is balancing the need to control costs in the exchange environment with their members’ ability to get the drugs they need at a cost that does not deter adherence.

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Posted on: 5/20/2014 8:47:48 AM


Louis ManningContributor: Louis Manning
Topics: Hospital formularies

It’s a common experience for frustrated patients across the country. They receive treatment in the hospital or undergo an expensive medical procedure, and then the bill comes with a litany of unexpected charges.
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Posted on: 5/15/2014 1:03:05 PM


Bill MelvilleContributor: Bill Melville
Topics: Exchanges, ACA

Cover Oregon, we hardly knew ye.

That’s primarily because the site never worked properly or enrolled a single Oregonian for 2014 coverage. Now the state is getting out of the health exchange business.
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Posted on: 4/25/2014 4:19:49 PM


Ric GrossContributor: Ric Gross
Topic: ACA, Massachusetts, exchanges

When it comes to healthcare reform in Massachusetts, a line from the classic Grateful Dead song, “Truckin’,” comes to mind—“What a long, strange trip its’ been.”

The saga began in April 2006 with a grandiose event at Boston’s Faneuil Hall, when Massachusetts’ then-governor, Republican Mitt Romney, signed the state’s near-universal healthcare law into effect. It was a made-for-TV event that certainly raised Romney’s profile as a ‘can-do’ governor.  A local headline read, “A Campaign Commercial in the Making.”  It was theorized that with the healthcare bill’s signing, Gov. Romney had given himself a significant legislative achievement whose coattails he could perhaps ride to the White House. A piece of bipartisan legislation enacted for the greater good—even some local Democrats were worried the spotlight was shining too brightly on Romney.
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Posted on: 4/23/2014 10:57:03 AM


Jacqueline CavnarContributor: Jacqueline Cavnar
Topics: Physicians, rural health, ACA

Long considered the equivalent of an NFL Draft Day for physicians, the National Resident Matching Program’s recent national match day ensured that more than 25,000 medical school graduates will pursue their training in primary care and specialty care. More than 40,000 physicians applied for nearly 30,000 positions.

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Posted on: 4/22/2014 10:10:56 AM


Jane DuboseContributor: Jane Dubose
Topic: pharmacy benefits, copay coupons

Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business (the coupons are not allowed for Medicaid and Medicare). Now, it appears the limb broke, and the company has essentially decided to backtrack. Read more.
Posted on: 4/15/2014 1:50:00 PM


Jane DuboseContributor: Jane Dubose
Topic: Copay coupons, pharma benefits, exchanges

Let’s imagine two cars speeding toward one another – in one car are branded manufacturers keen on protecting valuable drug franchises, and on the other are payers equally keen on tamping down drug costs, particularly on new specialty medications. Read more.
Posted on: 4/10/2014 3:47:50 PM


Lyda PhillipsContributor: Lyda Phillips
Topic: ACA, Massachusetts, healthcare costs, payment reform

The fundamental reasoning underpinning the Affordable Care Act is that having fewer uninsured people will ultimately lower healthcare costs for everyone. After all, those uninsured folks won’t be out there racking up medical claims that are eventually covered by everyone with insurance.

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Posted on: 4/10/2014 1:52:36 PM


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