Look to Automobile Insurance for Healthcare Answers

wrenches on garage wall, set of wrenches handy industrial tool,old wrenches in mechanic workshop,handy tool for motor vehicle mechanic use to fix motorcycle and car

We take care of our car. The oil, lights, brakes and steering are checked and in good shape, so we don’t expect anything mechanical to go wrong. Routine care costs are cheap and easy – besides, if the car is in bad shape the insurance company won’t cover it and it needs to pass a mechanical inspection… [Read More]

More Pharmacy Fixes

hundreds of colorful pills on black background for medicine themes

The collateral effect of writing these blogs is that insurance companies (I am happy to say many of them follow me) and third parties are quick to provide additional information or clarification to the issue at hand. There was quite a bit of follow up about my pharmacy blog last week. UnitedHealthcare let me know… [Read More]

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]

A Look at Catastrophic Claims in the World of Stop Loss

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Sun Life Financial recently released a report on the top ten claims conditions which give rise to stop loss claims under a self-insured healthcare plan. Sun Life analyzed four years of their catastrophic claims data and found that these ten claims represent 53% of all stop loss claims reimbursements. 26.6% of all stop loss claims… [Read More]

Controlling Specialty Drug Spending

Drug Cost  Specialty Pharmacy

Another commentary from the National Blue Cross Consortium. As I mentioned in prior posts, large claims are on the rise. Last year, Blue Cross paid their first individual claim for more than $15M, and the frequency of claims over $1M tripled from 2010 to 2015. Specialty medications are a real focus area. There is a… [Read More]

The New Front Door to Healthcare

Telemedicine

America is seeking a new normal in healthcare. At the National Blue Cross Consortium meeting this week, I listened to the consultant Oliver Wyman discuss future healthcare trends. The theory they are espousing is that Americans are changing the way they access healthcare. Telemedicine and retail clinics (Walmart/CVS) are increasingly becoming the new portal to… [Read More]

More Bad News for the Individual Exchanges

healthcare exchange

In what came as no surprise to the insurance world, Aetna announced it is losing money in its individual exchange business. This comes on the heels of both UnitedHealthcare and Anthem Blue Cross announcing they had lost money in this segment. As we have chronicled in the past, the exchanges are enrolling fewer people than… [Read More]

Is Consumerism a Field of Dreams?

healthcare cost2

The ACA Times, an online industry publication, recently reported on a JAMA Internal Medicine research survey of factors considered when choosing physicians. Significantly, only 10% of respondents considered changing doctors and only 4% considered cost comparisons when making their choice. This was the case whether the plan was a traditional plan or a high deductible… [Read More]

The Unanswered Questions of Tibble v. Edison

Supreme-Court

When the Supreme Court sent Tibble v. Edison back to the lower courts earlier this year, it left unanswered the primary questions about what level of plan fees is acceptable and what duty fiduciaries have in monitoring these fees. Tibble v. Edison involves participants suing their employer for offering investments at a more expensive cost… [Read More]