Retiree Healthcare Back in Focus

A mixed race senior couple is kayaking down a river together. The image's focus is on the elderly woman smiling in the foreground. She is Pacific Islander and has graying hair. Her husband is seen in a kayak in the background. In the distance behind the couple you can see the shoreline and a bridge. The happy couple are wearing casual clothing. It is warm outside.

With the upturn in the economy, employers are again starting to look at improvements to benefit programs, especially for their key employees. Retiree healthcare is a topic where I am surprised that discussions have changed from “how do I eliminate this obligation” to “tell me what other employers are doing for their key staff for post-employment… [Read More]

The CREATES Act – Stepping Closer to Drug Pricing Justice?

A blank doctor's prescription from a pharmacy is placed on American flag.

I don’t know about you, but the headlines on pharmaceutical companies substantially raising prices over a short period of time (without good reason) appear far too often for my taste – and we write about drug pricing issues frequently on this blog. But a quieter game of drug company manipulation has been taking place at… [Read More]

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]

Trump Opts for a Baby Step in the Drug Cost War – Not the Expected Leap Forward

Also drug dealing, dealer or trade concept.

Last week President Trump released his long-awaited “American Patients First” blueprint on attacking out-of-control pharmacy costs. Unfortunately, it’s more of a whimper than a roar. If the regulations are effectively written to support my understanding of the President’s intent, the incremental steps forward were not horrible, they are just not bold enough. Drug manufacturers will have to… [Read More]

Politics and Healthcare – Nothing Is Easy

Pink cherry blossom and magnolia trees blooming at the White House in Washington, DC during the springtime

I had the pleasure of spending the day on Tuesday in Washington to discuss my favorite legislative topic – healthcare. First stop, the White House, where I met with the Special Assistant to the President for Health Policy. This was a lively discussion which covered rising drug prices, the opioid crisis, mental health parity and… [Read More]

Warning – The Healthcare Status Quo Is at Risk

5-2-16 An Exciting Day in Washington

Whether the Affordable Care Act (ACA) was ever an effective way to combat the issues facing our healthcare system is arguable – but it is clear that our political process has not helped. The Commonwealth Fund recently reported that the uninsured rate for working-aged Americans (between 19 and 64) has increased from 12.7% in 2016 to… [Read More]

Reference-Based Pricing – Coming to a Health Plan Near You?

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I think you are going to hear more about reference-based pricing. Some history: What stops a provider from charging whatever they want for care? Let’s say a doctor charges $200 to remove a splinter. If the patient were paying, she/he might try to negotiate the charge or get care elsewhere. But they are most often not. The… [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]

Participation: Is It a Good Thing or a Bad Thing?

prepare filling item form, business background

One of the central tenets of underwriting medical plans is to avoid adverse selection at all cost. Adverse selection results when a plan is designed or priced in such a way that it only adequately incentivizes sicker employees to enroll; failing to attract good risk to offset the bad. For this reason, most insurers historically… [Read More]