A recent article in the NEJM argues that cost savings from
quality improvements are illusory because of the lumpy nature of healthcare
capacity. Quality’s impact on
utilization is just too small…
Several recent acquisitions suggest a rapidly growing valuation on Medicare Advantage (MA) lives. Last August, Healthspring paid about $3.6K per adjusted MA life with its acquisition of Bravo. (My …
UPDATE: United buys XL Health!
Here's what we surmised in the original post on this topic:
"That leaves United. A leadership position in C-SNPs would fit well with United’s leading position in…
In complex system, even small changes can have big, unexpected consequences. These are occasionally beneficial but more often than not have a negative impact.
Over the las…
Summary
Provider discounts are a key priority for national accounts – which puts CIGNA (CI) and Aetna at a disadvantage; CI responding in part by trying to get closer to providers
A provider collabor…
1. The final ACO rules largely maintain the demanding economic parameters for mature ACOs (Track 2) found in the originally proposed version (relative, for example, to the original PGP demonstration p…
Kaiser’s latest employer benefits survey offers some interesting data on the adoption of narrow (or high performance) network products. See chart below:
Couple of observations:
Overall adoption at …
Why would a health plan want to buy an exchange? Isn’t the only synergy if the owning plan tilts the exchange in their products favor? And won’t that damage the value proposition of the exchange for…
The Stewards-Tufts deal announced today will create a narrow network insurance product targeting the small group segment. As reported, members covered by the plan must get all routine care from Stewa…
Part of the theory of ACO value creation is trading off more primary care (resulting in better care coordination, fewer missed time bombs, and use of lower cost care options) against reduced use of sp…
A few weeks ago, UPMC announced an agreement among nine area systems to spend $4M over the next two years to launch a health information exchange called ClinicalConnect. Reportedly, Highmark (and pres…
Earlier this month, Blue Shield of California announced 2010 results from an ACO partnership with the Catholic Healthcare West hospital system and Hill Physicians. The ACO achieved savings of $20M on …
Much of the public speculation (for example here and here) regarding the acquisition of a local high quality safety net health plan -- is it about locking in Medicaid volume? or about doing a “good de…
Last week, the National eHealth Collaborative published a study of sustainability strategies for 11 leading health information exchanges (actually 12 including the VA). I’ll call these public HIEs to …
Historically Blues have shied away from Medicaid. Two thirds of plans do not serve any Medicaid and those that do often have disproportionately small shares. No real surprise: Medicaid specialist plan…
Summary
ESRX was running at close to maximum capacity at its mail facilities while MHS has room to spare.
ESRX is facing a scenario of significantly increased demand as greater mail penetration is …
UNH’s decision to take the commercial PBM business in-house did not force MHS into ESRX’s arms: I would argue that it removed the major roadblock to what the companies wanted to do anyway. MHS and ESR…
Payflex is an administrator of account-based benefits including HSAs, HRAs, FSAs and COBRA benefits. The company has $58M in revenues, 1M individual consumer accounts and 3,300 employer customers. On …
Highmark will invest up to $475M in the West Penn Allegheny Health System, a move characterized as a prelude to purchase. This is no bold move to drive closer integration of information flows and care…
Summary
Wellpoint probably paid full value for Caremore (if that company's performance is as powerful as limited data suggests) but did not overpay.
In addition, Caremore offers several powerful ups…
Summary:
Blue Shield of California (BSC) has committed to keeping profits at 2% of revenues or less (and returning any excess).
The commitment is economically meaningful: $180M of 2010 revenues will…
Yesterday, McKinsey released a report suggesting that 30% of employers will definitely or probably stop sponsoring health insurance after the Federal reform "big bang" in 2014. Although disputed by th…
Summary
Massachusetts small group went from an average actuarial value (share of expected medical costs covered by the benefit) of 85% in Q1-07 to 73% in Q4-09. In the same timeframe, actuarial benef…
Summary
Self-insurance is growing among smaller groups (including those sized 50-250)
From a competitive point of view, it will be hard for insurers holding attractive groups in risk products …
Public health insurers startled the market with earnings ~25% above consensus expectations. A key driver was lower-than-expected utilization (particularly in the under 65 commercial lives) which kept …
Summary
A new article in the NEJM suggests ACO economics will be unattractive because of the costly upfront investment and low probability of shared savings payments.
However, the results of the Med…
Summary
A new study from Center for Studying Health System Change suggests that new Medicaid eligibles under reform will have trouble getting access because most primary care are not accepting new M…
Summary
The line between health plan and provider continues to evolve: the Aetna-Carilion deal exemplifies providers backward integrating into insurance (and contrasts with other providers exit…
Summary
Health plan profits will be down dramatically in 2011 due to MLR rules
Providing care management services to providers building out ACOs and medical homes can open new revenue streams outsi…
Remember the idea that coordination will improve care? Well, if physicians do not get timely reports from other providers, their patients seem to have lower costs!!! This from a new study o…
New MedPAC report on Medicare fee for service utilization finds large geographic variation not explained by underlying risk or better outcomes. Another indicator of our HC system gone haywir…
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