UnitedHealthcare on the Forefront of Changing the Paradigm

Change concepts with yellow paper airplane

“Do you have the guts to break through where others don’t or won’t?” These are the words of UnitedHealthcare’s CEO on their mission to improve healthcare delivery in the United States. As this blog continuously chronicles, the system is fraught with deficiencies and opportunities for substantive improvement. Medical care has become too expensive. Delivery is… [Read More]

Is the Stop Loss Market Finally Firming?

Risk level knob positioned on medium position, white background and orange light. 3D illustration concept for business security management.

For self-insured employers, the stop loss or reinsurance market has been a haven for competition for many years. Fueled by the competitive forces of carriers entering the market and those seeking growth at all costs, pricing remained soft – insurers seeking rate increases were met with stiff competition and ultimately had to decide to either… [Read More]

Insurers and PBMs Taking Action on Opioid Abuse 

Opioid health risk and medical crisis with a prescription painkiller addiction epidemic concept as a group of people running away from a dangerous falling bridge of pills as a medicine addict problem with 3D illustration elements.

Pharmacy Benefit Mangers (PBMs), which run the drug plans for health insurers, are paid on the volume of drugs they sell and have been criticized for lack of transparency and focus on profits. Likewise, health insurers are generally focused on controlling claims costs and don’t fully consider the effects of their decisions to limit access… [Read More]

Insurers, Providers and Employers on a Collision Course 

Insurers, Providers and Employers on a Collision Course 

Trying to control healthcare costs is like trying to pick up Jell-O pudding with a pair of chop sticks. It is virtually impossible. The employer-based healthcare system relies on their intermediaries – primarily the large national insurers – to negotiate discounts, provide claims-paying acumen, fraud oversight and clinical expertise, among other things, in the administration of… [Read More]

Insurers Digging Through the Numbers on Oncology Treatments

Insurers Digging Through The Numbers On Oncology Treatments

One of the most difficult issues we face as a society is the cost of care for people who are terminally ill. In fact, most of a person’s lifetime healthcare spend is incurred at the end of their lives. With the advent, and ongoing issue, of skyrocketing pharmaceutical costs insurers are looking closely at the… [Read More]

Good News – the Stop Loss Market Is Vibrant

Good News – the Stop Loss Market Is Vibrant

Uncertainty and frustration abound in the healthcare market today, especially with all of the brewing legislative changes and tension over the market’s response. On the employer-sponsored plan side of things the challenge to improve affordability goes on as well – but you can only make so many plan design changes to keep up. High deductible… [Read More]

Cost-Control Over Risk: More Employers Embrace Self-Insurance

cost-control-over-risk

More and more employers are embracing self-insurance; according to the U.S. Department of Health & Human Services, more than 80% of companies with 500 or more employees have self-insured plans. That’s astounding in the context of historic statistics which showed that only the largest employers used this funding mechanism. And since new products from traditional… [Read More]

Politics and the Exchanges

Politics and Exchanges #3

We are all watching this train wreck unfold before our eyes. The individual exchanges were ill-conceived and poorly implemented from the onset. There is a bloodletting from the insurers, bankrupted co-ops, increased participant premiums, reduced plan options, and politicians looking to make the fixes (again). On one side, the government reports that costs are not increasing… [Read More]

Consumer-Driven Plan Enrollment Still Elusive in the Middle-Market

Consumer-Driven Plan Enrollment Still Elusive

High-deductible plan enrollment continues to grow across the country, but the enrollment is coming from the small group and exchange arena where most other traditional products have all but evaporated. National account segment customers have historically had an aggressive total replacement strategy toward these plans and make up a disproportionate percentage of the total enrollment. So… [Read More]