New Valuable Pharmacy App Solves a Big Problem

Pills on US dollars.

Why does pharmacy have to be so difficult? There seems to be a huge disconnect and a lot of finger pointing when it comes to prescribing drugs. A patient goes to the doctor and at the end of the visit gets prescribed medication to address the issue. Patients accustomed to the drill start to sweat… [Read More]

Another Band-Aid: Pharmacists Shopping for Patients

Cropped shot of shelves in a pharmacy

As anyone who has ever filled a prescription knows, the arcane and mind-numbingly complex pricing framework for drugs makes it both impossible to know what the drug will cost in advance of filling the prescription and similarly challenging to shop for a lower-cost alternative. With hundreds, if not thousands, of pharmacy benefit manager (PBM) and… [Read More]

Back to the Future of Healthcare

Wormhole right in time and space, clouds and millions of stars. Acceleration directly through this scientific wormhole with the space. 3d illustration

Today I listened to Cigna leadership discuss how they are responding to marketplace dynamics and I realized that this change is as cataclysmic as the HMO revolution was in the late 1980s. During that era, the number of insurance companies dwindled down to just a handful and the indemnity market went into a tailspin. Flash… [Read More]

Walmart-Humana and the Future of Healthcare

Fast speed dataflow.

Change and consolidation continue to sweep the insurance industry. Healthcare represents almost 20% of the U.S. economy. Costs are increasing and almost no one is happy. These are ingredients for change. The retail sales portion of the economy is also under extreme pressure – with thousands of stores closing and wildly-moving stock prices, this market is as ready for drastic… [Read More]

DOL’s Final Rule on Disability Claim Procedures

A gavel rests on its sounding block with a several law books and a justice scale out of focus in the background.  A cool blue cast dominates the scene.

I’ve been keeping my eye on movement here for well over a year and after some delay, the Department of Labor (DOL) issued final regulations amending the existing claim procedures for ERISA-governed plans providing disability benefits. The DOL is looking to provide needed protections for American workers, and any disability claims filed on or after April… [Read More]

A Conversation with Dave Cordani, President and CEO of Cigna, About Express Scripts

White Speech Bubble Hanging on the Green Background

I had the opportunity to talk to Dave Cordani, President and CEO of Cigna regarding their planned purchase of Express Scripts. The health insurance carriers get it – they very much need to bring solutions to the market or solutions, which may not be optimal to the carriers, will be imposed upon them. Cigna’s intent is to create… [Read More]

Emergency Room Claims – Self-Diagnose or Pay the Price?

An emergency department sign.

While most of us know that emergency room (ER) care is more expensive that non-emergent care, you may not have realized just how much more. In some cases, you could be responsible for the entire cost of your hospital ER visit. We’re hearing an increasing number of stories from patients who are being billed for the… [Read More]

ACA Penalties for Failure to Provide or Have Coverage Are Still Around

finance business calculation with calculator and pen on chart

There is a lot of confusion out there concerning ACA penalties. The 2018 tax act did not eliminate any employer penalties for not offering health insurance coverage. The only change was reducing the individual coverage penalty to zero – however, this change does not go into effect until 1/1/2019. Applicable large employers (ALEs) with more… [Read More]

Aetna – Reshaping Healthcare

Doctors and nurses taking care of the patients and connecting together: healthcare and technology concept

I just attended the Aetna National Broker Advisory Council Meeting. This is a very inspiring meeting to me, one in which I learn of the ways Aetna is helping to tackle the biggest issue in healthcare today: COST! While the CVS-Aetna merger is awaiting approval, it’s nice to hear that Aetna is moving forward with their… [Read More]