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]

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]

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]

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]

2017 Kaiser Family Foundation Survey Results

medical cost, stethoscope on dollar banknote money. concept of health care costs, finance, health insurance fund.

Kaiser has just published its 2017 annual benefits survey and I think the folks in Washington, D.C. all need a copy. Approximately half of the United States’ non-elderly population gets healthcare coverage through their employer, so this survey reveals what many Americans are experiencing. While employer coverage is far better, in many respects, than the coverage… [Read More]

Healthcare Reform… More of the Same

Healthcare in the Trump Era Takes Its First Step

The Senate is making one last-gasp effort to repeal ACA… Well, not actually repeal, just reconfigure. Lindsey Graham and Bill Cassidy have sponsored a bill, which will be eligible for consideration under budget reconciliation rules (i.e. 51 votes required to pass and not subject to filibuster). Under the bill the amounts paid by the federal… [Read More]

Anthem Gets Tough with Hospitals

Anthem Gets Tough with Hospitals2

One of the greatest frustrations our self-funded (and to a lesser extent, fully-insured) clients voice is that – despite the hundreds of thousands or millions of dollars they pay the insurers to assist in managing their health plan spend – too often it appears the insurers are complicit in the rising healthcare spend by not… [Read More]

Another Blow to the Healthcare Exchanges as CareConnect Shutters

No Easy Answers Another Blow to Healthcare as CareConnect Shutters

CareConnect, the upstart insurance company founded in 2014 by Northwell Health in the Downstate New York marketplace, has made the decision to cease operations. It made a lot of sense that Northwell, a hospital chain with extensive provider connections, could cut out the middleman insurance company and offer insurance protection directly to its customers. It didn’t… [Read More]

States Petition to Chart Their Own Healthcare Course

States Petition to Chart Their Own Healthcare Course

­­The Trump administration has indicated a willingness to liberalize the Section 1332 State Innovation Waiver under the Affordable Care Act (ACA) to make it easier for states to provide affordable coverage. So far, only Hawaii has been granted the ability to deviate from the ACA, but now Iowa will be testing the President’s stomach on… [Read More]