At a TEDMED conference a couple years ago, I had to write some sample “ask me” questions on the bottom of my ID badge as conversation starters. One of them was “Ask me why PHIX+ACO=:-)” Given the p…
Summary
Highmark and the West Penn Allegheny Health System (WPAHS) are not aligned on their vertical strategy to counter UPMC in the Pittsburgh market
WPAHS can only absorb a portion of Highmar…
Summary
Two major hospital systems have agreed to a joint venture to explore growth opportunities on a “case by case” basis
One system is a major non-profit, the other a PE-backed for profit serial a…
We live in a society with too much data. In the field of market research, the deluge of data is cited as one of the top challenges leaders face as they search for actionable insights hidden in the dat…
Today’s piece in Kaiser Health News that hospitals' readmissions rates are flat appears to suggest various ongoing efforts to cut readmissions are failing and failing badly.
According to the Medicare …
Summary
HIV Special Needs Plans (SNPs) offer extra layers of services specialized for the HIV/AIDS patient and can generate attractive savings particularly in reduced in-patient costs
A new par…
Summary
The case for an oncology ACO can be compelling but CMS rules for ACOs within fee-for-service (FFS) make value difficult to demonstrate
A new physician-hospital-payer partnership in Florida …
Last month, NY and PA announced plans for how they will integrate data sharing across local HIEs.
The state planning efforts share some key parameters:
Roughly equal funding with about $20 million i…
Earlier this month, Heartland Health signed a deal with the Mayo Clinic for its doctors to virtually consult cases with Mayo physicians in return for an undisclosed fee. Heartland Health is a reg…
BCBSMN has licensed the platform for its private health insurance exchange (PHIX) and defined contribution product from eHealth (original announcement April 30). For eHealth, which has seen its gover…
With its acquisition of Extend Health, Towers Watson has ensured that (1) PHIXs will be a key competitive arena among the major benefits consultants and (2) that it has taken the lead. Extend Health…
Last week, CIGNA acquired the Great American Supplemental Benefits from American Financial Group (AFG) for $295M in cash. Per press releases, the key financials for the acquired business are:
A f…
Summary
Aetna has struck a deal to sell individual health insurance with Costco, the #6 retailer. The deal targets 9 populous states first with more to follow in 2012
While the deal lacks some…
There have been some blog posts (here and here) about a discussion on payment reform at the Massachusetts Health Data Consortium last week. While I did not attend, the commentary is provocative and I…
Summary
Geographic barriers to provider competition are a headache for payers
By importing capabilities, specialty franchising could help reduce some of the barriers to cross-geography competition
It…
Next week, the California insurance commissioner will propose legislation to deter small employers from exiting the traditional health insurance market and going self-insured. The legislation will pu…
The PE firm TPG is reportedly considering investing in LHC, a publicly-held home health agency (LHC announced earlier this year they were exploring strategic options). PE funding could allow LHC to p…
Summary
Administrative clearinghouse NaviNet has been acquired by 3 Blues plans and a provider of analytics capabilities for plans and providers (Lumeris).
Both NaviNet and Lumeris appear to ne…
Yesterday, Aetna announced a deal with Heartland Health (an integrated delivery system serving northwest Missouri, northeast Kansas and southeast Nebraska) to create a new health plan for the small gr…
Aetna has struck a deal with Best Buy to sell four online coaching programs (fitness, weight management, smoking cessation and stress management) in
new 1,200 sq. ft. “health technology departments” i…
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