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]

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]

Take Politics Out of Healthcare

Medical politics and health reform challenges or universal healthcare system stress concept as a group of opposing ropes pulling on a doctor stethoscope as a medicine management symbol with 3D illustration elements.

Three additional states have joined California in an investigation of the third largest insurer in the United States – Aetna – alleging their medical director denied a $20,000-per-dose infusion, admitting in a deposition that he never looked at [the] patient’s medical records. The media and public have cried out that the insurer has put profits over patient… [Read More]

Can You Believe What Happened to Me at the Pharmacy?

pharmacy counter with blur shelves of drug in the pharmacy drugstore background

This is going to be a rant blog. I happen to know that a lot of people from Aetna (which is my insurer) read this. But, it really doesn’t matter whether it’s Aetna or another medical insurer – they all have the same issues. Thankfully I am reasonably healthy. As with most people, my most frequent encounter with the… [Read More]

Preventive Care that Actually Saves Money… Dental

Toothbrush and toothpaste in the bathroom close up.

Over the last two decades, the healthcare industry has tied itself in knots in order to validate the business case behind preventive medical care. And although preventive care services offer a variety of benefits – social and humanitarian, for example – the data seems almost conclusive that economics is not quite one of them. Too… [Read More]

CVS-Aetna – a Few Weeks Later

Doctor sitting at table and working with tablet. Medical icons in hexagonals in front. Only hands seen. Concept of medical help.

So the CVS-Aetna deal has been seasoning a bit and I really haven’t heard of any major roadblocks to approval. And early integration planning is starting. Not that integration teams are that much of an indication as they didn’t portend a good result for the Aetna-Humana or Anthem-CIGNA mergers. It would seem that horizontal integration is… [Read More]

Donald J. Trump – To the Tune of “Alexander Hamilton”

ThinkstockPhotos-92369411crop

A common theme discussed in this blog this year has been remaking healthcare as we watch the twists and turns unfold in the legislative circus of healthcare reform. To close out 2017, we’ve put a musical spin on healthcare in America. SHARE THIS!

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]