Will the Urge to Merge Help Healthcare?

Businessmen connect puzzle lamp. Joint efforts, success, union, idea. Vector illustration Eps 10 file. Success Cooperation

The announcement this week that CVS would be acquiring Aetna is the latest effort to remake U.S. healthcare. Costs are still spiraling upwards at an unsustainable rate and try as we can, inertia makes efficiency and cost reduction battles difficult to win. “Bigger” hasn’t done much to reduce costs. The health insurance market is down to… [Read More]

In Healthcare, the Art of the Deal is Not So Artful

In Healthcare, the Art of the Deal is Not So Artful

The Washington shenanigans continue as President Trump holds out the specter of supporting the bipartisan Alexander-Murray Senate bill which attempts to shore up the Affordable Care Act and set up a reinsurance fund for large claims. The president has also promised to back off his threat to cut off funding of cost-sharing subsidies. All this… [Read More]

Facility Fees: An Alarming Billing Trend That May Cost You

Facility Fees - An Alarming Billing Trend That May Cost You

Get this – an employee decides to see an in-network doctor for a medical issue. At the end of the visit, they pay the applicable office visit copayment. All good? No. Facility fees charged by hospital-owned clinics are a new wrinkle in the reimbursement battle. In addition to the charge for the doctor’s services, patients are… [Read More]

What Repeal of the Individual Mandate Would Mean to Americans

ThinkstockPhotos-122516159

The Republicans are at it again. The latest negotiations in the Senate on their tax bill have led them back to a proposal to eliminate the individual mandate under the Affordable Care Act. The lure of more than $300 billion in tax savings as calculated by the nonpartisan Congressional Budget Office (CBO) is too big a number… [Read More]

ACA Penalties Are About to Hit Employers

ACA Penalties Are About to Hit Employers

Reach way back into your memory bank to the time when your broker presented you with a “pay or play” analysis to determine whether you comply with the employer mandate under the Affordable Care Act. There was the $2,000 penalty which applies to every full-time employee in the event there was no valid offer of… [Read More]

Healthcare is a Three-Ring Circus

Vector illustration of cartoon circus tents on a blue sky background. Vector eps and high resolution jpeg files included

Open enrollment has started for the 1/1/2018 policy year and anyone faced with a purchase decision is surely confused. On the off chance that any of those prospective healthcare exchange customers are following this blog I thought I would take this opportunity at the start of the shortened open enrollment period to clarify the rules:… [Read More]

Start with Pharmacy to Reduce Healthcare Costs

Medical golden capsule full of coins isolated on white background

I was at dinner the other night discussing President Trump’s lashing out at insurance carriers and issuing an executive order to suspend federal funding for exchange cost-sharing subsidies (which last week I said was misguided). And my friend, a former insurance company executive, pointed out that since the Affordable Care Act’s passage, healthcare company profits and… [Read More]

Healthcare Reform – Finally a Movement Toward Bipartisan Cooperation

Are Association Health Plans a Good Idea

The nine million Americans covered by the federal healthcare exchanges must be feeling a lot like a ping pong ball… It’s a good thing the ball is moving so fast they can’t see it. President Trump has reversed himself again and indicated that he would not support a bipartisan effort to plug some of the holes… [Read More]

Extreme Healthcare Chaos

Stethoscope with American Flag Reflection on Wooden Table.

Turmoil by executive order again… On Thursday, President Trump threw two more giant logs on the raging healthcare marketplace fire by ordering the discontinuance of federal funding for cost-sharing subsides for low income Americans and by directing the Secretary of Labor to provide guidance on liberalizing association healthcare plan rules. Cost-sharing subsidies made healthcare affordable… [Read More]

Getting Creative in Combating Rising Specialty Drug Costs

Pills dollar symbol

High cost drugs are the most significant cost driver in healthcare today. Because of their therapeutic value (they cure illness), it is very difficult to manage the cost of these specialty medications. Prior approval, quantity limits and high cost-sharing have proven to be among the most effective utilization mechanisms. A study published in The Journal… [Read More]