Healthcare Has Been Screaming for a Disruptor

businessman screaming news, or adult who asks a job - communication

Someone heard. Rumors have been swirling that Amazon, the market status quo killer, was setting its sights on healthcare – one of the least transparent and most inefficient markets – which accounts for almost 20% of U.S. Gross Domestic Product (GDP). Today Amazon joined with market-savvy Berkshire Hathaway and JPMorgan Chase to announce that a new… [Read More]

Chipping Away at the Affordable Care Act Isn’t Getting to the Real Issue

Health Care Reform sign

So, the Affordable Care Act’s (ACA’s) individual mandate penalty has been reduced to zero, the Cadillac Tax has been delayed for two more years (and may likely never be implemented) and the Children’s Health Insurance Program (CHIP) has been funded for six years. Now more than 1.75 million children in 20 states, who were at risk of losing their healthcare, can breathe… [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]

Comparing Discounts in a Self-Insured Arrangement

Comparing Discounts in a Self-Insured Arrangement

In a self-insured plan, where 85% or more of cost is the actual payments made for medical claims, one of the most important factors to consider is the network; which one will provide the best access and which will yield the best provider discounts. Let’s start with access: which network most closely aligns with the providers your employees and… [Read More]

Healthcare. Okay. Now What Do We Do?

Flag and Stethoscope

What a week it’s been. I am not sure why President Trump thinks that his latest attempt to coerce the Republican Congress will work better than his past efforts. The Democrats relied on 50 votes to get the Affordable Care Act (ACA) through and now the Republicans are trying to rely on 50 votes to make… [Read More]

Fighting Pharmacy Inflation

Fighting Pharmacy Inflation

There is an inherent battle between employers and their pharmacy benefit managers. Simply put, PBMs get paid on the volume of drugs dispensed and have little incentive to control utilization of expensive medication. Even worse, drug rebate allocations skew incentives even more when PBMs or health plans use rebate sharing to enhance profits. Consider this:… [Read More]

New York’s Surprise Healthcare Bill Will Be a Surprise to Taxpayers

Money coming out of jar

New York’s “Emergency Medical Services and Surprise Bills” law is in effect as of March 31. This should be good news to consumers who might be billed for out-of-network services when care is rendered by a doctor outside the network without the patient’s knowledge or consent. The law also permits consumers to seek care from… [Read More]

Insurers Rapidly Transforming to Survive and Thrive

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Insurers are quickly making changes that will ensure their viability for the long term. In response to the never-ending challenge of escalating costs, many changes were already underway before the Affordable Care Act. Some are the result of the marketplace evolution toward more consumer involvement, which the ACA has accelerated. Long functioning in the B2B… [Read More]

Coming Your Way? Transparency Spurs a Price War and Affordable Healthcare Options

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Surgery at a fourth or fifth of the price that you’d expect from your local hospital? Is it possible? In Oklahoma at Surgery Center of Oklahoma, where prices posted online are staggeringly lower than those of neighboring hospitals and medical centers, patients are actually seeing affordability in some healthcare costs. As consumers, we hold a… [Read More]