Precision Benefit Design

A recent viewpoint from Fendrick and Shope (2018) argues for the need for Precision Benefit Design. Successful implementation of precision medicine will need to address several system-wide challenges, including administrative complexities, the creation of new financing models, and aligning provider- and patient-focused initiatives. The enormous clinical potential of precision medicine sheds light on the critical…

Managed Competition in 2018

Alain Einthoven is the father of managed competition.  In a recent Health Affairs article, he and Laurence C. Baker look ]at managed competition in California and ask whether the standard conception of managed competition needs to be altered. Before we get to the article, we first need to ask a basic question: what is managed competition?  The…

The big tech innovation from Amazon-Bershire Hathway-JP Morgan joint venture could be…

Narrow networks?  That is one proposition from Bill Gurley, a general partner at Benchmark Capital, in an article from Business Insider.  Berkshire Hathaway vice chairman Charlie Munger, prefers the Kaiser model. “If the whole nation had Kaiser Permanente care, the average quality of the care would go way up and the cost would go way down,”…

The importance of competition in ACA marketplaces

Competition matters for markets…even health care markets. A paper by Van Parys (2018) relies on a database of plan premium and market characteristics among states with federally-facilitated health insurance exchange Marketplaces.  In this analysis, she finds that: In 2018, Marketplace premiums were 50 percent ($180) higher, on average, in rating areas with monopolist insurers, compared…

Does health insurance save lives?

According to one study by Martin Anderson presented at the NBER’s Program on Health Economics meeting May 4, the answer is yes.  Dr. Anderson examines the changes in insurance coverage, health care utilization, and mortality after the expansion of Medicare coverage to all patients with end stage renal disease (ESRD).  The study finds that: …the expansions…

Is Medicare Advantage risk adjustment fair? And if not, what should we do about it?

While most patients in Medicare use the traditional fee-for-service route, a growing percentage of Medicare beneficiaries are relying on managed care plans through Medicare Advantage.  Medicare Advantage provides beneficiaries with additional choice and also serves as a competitive alternative to traditional Medicare.  In theory, Medicare should just allocate a beneficiary’s funding to a managed care…