Healthcare Reform Blog

Roy MooreGuest Blogger from Decision Resources: Roy Moore
Topic: Medicare, Part D, MLR, CMS

The Centers for Medicare & Medicaid Services made a decision last week that could cut into the profits of Part D plans and certainly focuses more attention on how they are spending premium revenue.

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Posted on: 5/29/2013 12:36:26 PM

Joyce CaruthersContributor: Joyce Caruthers
Topic: Medicaid, ACA

Are all states destined to have managed Medicaid programs, regardless of how their current Medicaid programs are performing? That’s a question that should be top of mind as North Carolina intends to apply for a Medicaid waiver that would allow the state to move from a primary-care case management program to a managed Medicaid program.
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Posted on: 5/24/2013 1:01:34 PM

Ric GrossContributor: Ric Gross
Topic: Exchanges, CO-OPs

Rhode Island being the smallest state, you might think word would travel faster there. But according to a recent survey commissioned by the Rhode Island Health Benefits Exchange, four out of five state residents have never heard of the exchange. So much for brand awareness. Regardless, Rhode Islanders—and consumers across the nation—best do their homework as the October 2013 exchange launch date, for coverage effective Jan. 1, 2014, rapidly approaches. The structure of state exchanges, including participating health plans, is taking shape, and there are developments worth noting in one of the bellwether exchange regions—New England.
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Posted on: 5/23/2013 2:56:15 PM

Lyda PhillipsContributor: Paula Wade
Topic: Exchanges, medical loss ratio, rate increases, national MCOs

Is it just me, or is anyone else getting tired of all the poor-mouthing by the quite profitable health insurance industry?

After posting hefty profits in 2012, the publicly traded health plans have released pretty darn good first-quarter earnings and most even upped their forecasts for the year. Aetna, Cigna, Humana and UnitedHealth Group reported profit margins in the 5 percent range, good by insurance industry standards (a few years ago they averaged in the 3 percent range). For UnitedHealth, that amounted to $1.24 billion, or a 4.09 percent margin. And, by the way, their stock prices are up.

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Posted on: 5/22/2013 5:15:18 PM

AnnJeanette Colwell

Contributor: AnnJeanette Colwell
Topic: Physicians, managed care, ACA

Physician leadership was a recurring theme at the National Association of Managed Care Physicians conference in Orlando, which I recently attended. Indeed, the topic is becoming more prominent at a number of conferences focused on preparations for healthcare reform.

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Posted on: 5/20/2013 3:25:09 PM

Chris Clancy

Contributor: Chris Clancy
Topic: Pharmacy benefits, P&T committees, value-based formularies

When it comes to assessing the clinical benefits of a drug and deciding on which tier that drug is placed, the conversation traditionally begins and ends with a plan’s Pharmacy and Therapeutics Committee. However, now that Premera Blue Cross in Washington has seen its value-based formulary implemented by a couple of large, healthcare-related employers in the Puget Sound area, a new avenue of cost savings may exist for insurers wanting more bang for their drug-purchasing buck.

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Posted on: 5/16/2013 1:41:53 PM

Contributors: Laura Beerman and Ed Park
Topic: ACOs, hospitals, medical devices, healthcare reform

A recent survey by consultants L.E.K. of more than 200 hospital executives paints the picture: the next five years will likely see spending decreases for large device med tech spending. With 80 percent of those respondents already members of or planning to join accountable care organizations, there are three things med tech should put on its radar.

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Posted on: 5/14/2013 12:51:17 PM

Bill MelvilleContributor: Bill Melville
Topic: Health exchanges, health plans, ACA

Every time a health plan reveals its health exchange strategy, the market winces. The same holds true when health exchanges pulling back the curtain on participating plans.

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Posted on: 5/8/2013 1:57:48 PM

Sarah WilsonContributor: Sarah Wilson
Topic: M&A, ACA, health systems

Nordstrom, Facebook, Starbucks and Google are considered to be some of the best companies to work for, in no small part due to their company cultures. From a healthcare standpoint, Cleveland Clinic is thought to have one of the best cultures, or unique practices separating it from others. There is a great emphasis placed on a company’s ability to establish and maintain a successful culture. However, this can be challenging when organizations undergo consolidation.
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Posted on: 4/24/2013 10:42:53 AM

Chris LewisContributor: Chris Lewis
Topics: ACA, CalPERS, state employee benefits

As health reform starts in earnest in 2014, health plans in California will not only be jockeying for insurance exchange members but also for the business of state employees and retirees.

In a decision that could significantly alter commercial insurance market share over the next five years, the California Public Employees Retirement System—with a total of 1.3 million members—has opened up the statewide HMO business to four other carriers, dependent upon their ability to successfully negotiate contracts with the agency, a process now underway.

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Posted on: 4/22/2013 2:36:12 PM

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