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…

Health insurance is not enough

Having health insurance is great.  It largely protects people against financial losses that accrue when you become ill.  It provides coverage for medical services.  And improves patients health. Well, that last one is only true if health insurance allows you to access care.  When health insurance provider reimbursement is low as is the case for…

Patient-Centered Formularies: Steps In The Right Direction, But Challenges Remain

That is the title of my latest blog post in Health Affairs with co-author Mark Linthicum.  The premise is as follows: CVS recently announced its new Transform Rheumatoid Arthritis Care initiative, which aims to reshape coverage of rheumatoid arthritis care through “value-based management strategies including outcomes based contracts and a new indication-based formulary for autoimmune…

Why would Walmart want to buy Humana?

Walmart is a mega-retailer.  Humana is a health insurer.  Yet Walmart is in talks to either partner with or outright purchase Humana.   Why would Walmart want to do this?  My By becoming a health care provider, Walmart’s image will improve. By becoming a health care provider, Walmart stores will get more traffic as people shop…

Obamacare premiums rose 32% in 2018

Between 2017 and 2018, premiums Obamacare health insurance plans plans rose by 32%.  To be more specific, the Urban Institute reports that: The national average increase was 32.0 percent for the lowest-priced silver plans and 19.1 percent for gold plans, but the increases varied by states…State changes in average lowest-priced silver premiums ranged from a 22.5…

Cigna-Express Scripts merger

Today, Cigna purchased Express Scripts for $52 billion.  This follows another mega-deal where CVS bought Aetna.  The integration of pharmacy benefit managers (PBMs) and insurers is nothing new.  Previously, many insurers managed their own pharmacy benefit.  However, as PBMs grew in size and were able to get larger discounts and rebates, in-house PBMs became less…