Dec 2011 “Savings illusion” can become savings reality in the long haul: baby boomers to the rescue By Tory Wolff Payers , Providers A recent article in the NEJM argues that cost savings from quality imp… Read more
Dec 2011 Bubble in acquisition pricing of Medicare Advantage lives? By Tory Wolff Payers Several recent acquisitions suggest a rapidly growing valuation on Med… Read more
Nov 2011 XL Health in play: what do the three suitors see? By Tory Wolff Payers UPDATE: United buys XL Health! Here's what we surmised in the origin… Read more
Nov 2011 Emerging Unintended Consequences of Health Care Reform By Nikhil Bhojwani Payers , Providers In complex system, even small changes can have big, unexpected consequ… Read more
Nov 2011 The CIGNA-Healthspring deal: local share key to top-line synergies but still missing from the equation By Tory Wolff Payers , Providers Summary Provider discounts are a key priority for national accounts –… Read more
Nov 2011 Six strategic choices made by CMS in the final ACO rules By Tory Wolff Payers , Providers 1. The final ACO rules largely maintain the demanding economic paramet… Read more
Sep 2011 Narrow networks: adoption growing among smaller groups By Tory Wolff Payers , Providers Kaiser’s latest employer benefits survey offers some interesting data … Read more
Sep 2011 Private health insurance exchanges and defined contribution: thoughts on Wellpoint’s acquisition of Bloom Health By Tory Wolff Payers Why would a health plan want to buy an exchange? Isn’t the only syner… Read more
Sep 2011 The Steward-Tufts deal and the looming threat of provider-led narrow network insurance By Tory Wolff Payers , Providers The Stewards-Tufts deal announced today will create a narrow network i… Read more
Sep 2011 A gradual roll-out of ACOs will minimize disruption and resistance By Tory Wolff Payers , Providers Part of the theory of ACO value creation is trading off more primary c… Read more
Sep 2011 Upping in ante in Pittsburgh: the health information exchange arms race By Tory Wolff Payers , Providers A few weeks ago, UPMC announced an agreement among nine area systems t… Read more
Aug 2011 Provider incentives in the commercial ACO: retaining a small share of savings in return for future volme growth By Tory Wolff Payers , Providers Earlier this month, Blue Shield of California announced 2010 results f… Read more
Aug 2011 Partners’ acquisition of Neighborhood Health Plan: reinforcing the role of community health centers in the care continuum By Tory Wolff Payers , Providers Much of the public speculation (for example here and here) regarding t… Read more
Aug 2011 The curious absence of payers in public HIEs By Tory Wolff Payers Last week, the National eHealth Collaborative published a study of sus… Read more
Aug 2011 Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal By Tory Wolff Payers Historically Blues have shied away from Medicaid. Two thirds of plans … Read more
Aug 2011 ESRX-MHS Part 2: mail facility speculations (…or: Indulging my Inner SWAGer) By Tory Wolff Payers Summary ESRX was running at close to maximum capacity at its mail fa… Read more
Jul 2011 ESRX-MHS Part 1: Last stand of the PBM pure play: observations on the Medco-Express combination By Tory Wolff Payers UNH’s decision to take the commercial PBM business in-house did not fo… Read more
Jul 2011 Consumerism bulk-up: Quick thoughts on Aetna’s acquisition of PayFlex By Tory Wolff Payers Payflex is an administrator of account-based benefits including HSAs, … Read more
Jun 2011 Highmark and West Penn: it’s about mitigating consolidation, not transforming the system By Tory Wolff Payers , Providers Highmark will invest up to $475M in the West Penn Allegheny Health Sys… Read more
Jun 2011 Did Wellpoint overpay for Caremore? No….not yet anyway By Tory Wolff Payers , Providers Summary Wellpoint probably paid full value for Caremore (if that comp… Read more
Jun 2011 Blue Shield of California’s unilateral profit cap: competitive gambit or PR move? By Tory Wolff Payers Summary: Blue Shield of California (BSC) has committed to keeping pro… Read more
Jun 2011 Employer opt-out as a result of reform: survey vs. model By Tory Wolff Payers Yesterday, McKinsey released a report suggesting that 30% of employers… Read more
Jun 2011 Rapid shift to “bare bones” coverage among Massachusetts small employers: preview of Federal reform impact? By Tory Wolff Payers Summary Massachusetts small group went from an average actuarial valu… Read more
May 2011 Rise of self-insurance in smaller groups: opportunity and threat By Tory Wolff Payers Summary Self-insurance is growing among smaller groups (includi… Read more
May 2011 Major health plan Q1 earnings: Profit surprise in commercial risk; multiple reasons why business prospects look good By Tory Wolff Payers Public health insurers startled the market with earnings ~25% above co… Read more
Mar 2011 ACO profitability: Reasons for optimism By Tory Wolff Payers Summary A new article in the NEJM suggests ACO economics will be unat… Read more
Mar 2011 Primary care capacity and the looming Medicaid surge: Medicaid-focused providers must be part of the answer By Tory Wolff Payers , Providers Summary A new study from Center for Studying Health System Change su… Read more
Mar 2011 Revolution in Roanoke? Perspectives on the Aetna-Carilion deal By Tory Wolff Payers , Providers Summary The line between health plan and provider continues to … Read more
Feb 2011 How can a health plan weather the MLR hit to profitability? Some clues from Coventry By Tory Wolff Payers Summary Health plan profits will be down dramatically in 2011 due to … Read more
Feb 2011 Conventional wisdom that provider capacity drives cost questioned in new study By Nikhil Bhojwani Providers Remember the idea that coordination will improve care? Well, if physic… Read more
Jan 2011 Surprising implication of drivers of Medicare FFS variation – MedPAC By Nikhil Bhojwani Payers New MedPAC report on Medicare fee for service utilization finds l… Read more
