UnitedHealthcare on the Forefront of Changing the Paradigm

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“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]

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

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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]

Message Heard – Pharmacy Costs are in the Spotlight

Rx Prescription #2

No doubt the health insurance carriers are getting the message: pharmacy costs are too high, and pricing is not transparent. UnitedHealthcare has announced that they will begin passing rebates directly to retail purchasers at the point of purchase. Pharmacy rebates – which are usually shared between the pharmacy benefits manager (PBM) and the health insurer… [Read More]

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

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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]

Out With the New and in With the Old

Health Insurance Changes

After last year’s collapse of the New York health insurance co-op, Health Republic, the depleted health insurance market for employers with less than 100 employees can expect the return of an old player: Blue Cross Blue Shield. But this old player is changing up tactics a bit. Operating as Empire BCBS in NY, this insurer… [Read More]

My Recent Experience with Opioid Based Rxs

Rx Prescription #2

There seems to be an increasing focus on the opioid epidemic engulfing our country. Growing addictions to prescription painkillers and heroin are wreaking havoc on our communities, destroying lives and families. How did we get here? Voters in the State of New Hampshire recently ranked drug abuse, especially opioid addiction, as the most important issue facing… [Read More]

Health Insurer Merger Mania

Health Insurer Merger Mania

It’s official – Anthem, the Blue Cross franchise aggregator, will be acquiring Cigna for $54 billion, which would make them the largest health insurer. Earlier this month, Aetna Inc. agreed to buy Humana Inc. for $37 billion, and Centene Corp. announced it would acquire Health Net Inc. for $6.3 billion. My father used to say,… [Read More]

A Talk with Dave Cordani of Cigna

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On Wednesday I attended a meeting with Dave Cordani, the CEO of Cigna. He is considered one of the big thinkers in healthcare and I am happy to say that his talk was very much in line with the blogs I have been publishing. Healthcare is changing. Our country is moving from pay-for-volume to pay-for-value…. [Read More]

Exchanges Draw Crowds…but the Big Names Sit It Out

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From coast to coast, the new normal in healthcare was revealed on October 1. On that date Americans, if they could log on (and let’s assume they will eventually be able to—although some are still skeptical), learned the cost and benefits of the metal plans in each market. And we are hearing a big backslap… [Read More]

Employers Find Solutions to Rx Gamesmanship That Increases Their Costs

Facing the erosion of profits due to high-cost brand name drugs coming off patent, the pharmaceutical industry has found a way to keep the profits rolling in. Pharma would like members who face higher copays and costs for name-brand medications with generic alternatives to stay on the branded drugs. To do so, they spend $3-$6… [Read More]