Several hundred perspectives on the questions facing payers, providers, biopharma, medtech, and digital health — plus our running read on the clinical literature. Start with our sharpest work, or filter to your world.
An opinionated take on NEJM highlights for September 2018
By
Marc Herant
NEJM
Primary care organizations are better ACOs when it comes to achieving …
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NEJM Highlights for July 2016: Bayesians vs. frequentists, PCPs vs. specialists, SGLT-2 vs. GFR
By
Marc Herant
NEJM
Adaptive clinical trials slowly coming of age
In an adaptive clinical …
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NEJM Highlights for June 2016: Improving care delivery is just plain #%^*! hard
By
Marc Herant
NEJM
Disappointing interim results from two ACA experiments
Two papers repo…
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So what if PCPs in ACO practices are not paid differently?
By
Diana Poon
Providers
In a recent study, Ryan, Shortell, et al analyzed the composition of P…
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NEJM Highlights May 2015: a read on ACO performance, progress in cystic fibrosis treatment, yes developing new drugs is expensive, rethinking industry-medicine relationships, CVS Caremark and smoking cessation
By
Marc Herant
NEJM
Early results of the ACO experiment: directionally right, but impact i…
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A sizeable step forward but miles still to go: CMS’ Next Generation ACO model
By
Tory Wolff
Payers
,
Providers
CMS has issued a “Request for Applications” describing its Next Genera…
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Cosgrove moves south: competitive implications of the formation of the Midwest Health Collaborative
By
Tory Wolff
Providers
A few days ago, Cleveland Clinic announced the formation of the Midwes…
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The “weaponization” of ACO narrow networks: Strategic destabilizers which compel their own replication?
By
Tory Wolff
Payers
,
Providers
In theory, narrow networks built around a single provider or a network…
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Boeing’s model for creating product-based competition among providers
By
Tory Wolff
Providers
Summary
Boeing is creating a benefit design model which sets up provi…
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Can drug companies make drugs, AND money?
By
Nikhil Bhojwani
Biopharma
,
Payers
In this morning’s New York Times (June 3,2014), Andrew Ross Sorkin ask…
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Aetna not conceding the private exchange space to the benefits consultants
By
Tory Wolff
Payers
Summary
Aetna is stitching its inventory of ACO deals into a national…
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Strategic “crowd-out” via narrow networks: an emerging case study in Wisconsin
By
Tory Wolff
Payers
,
Providers
Last week, I argued that, if payers want to secure competitive advanta…
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ACO proliferation and provider “all-payer” care models inexorably lead to tighter network strategies
By
Tory Wolff
Payers
,
Providers
A new study in JAMA (by McWilliams et al.) looks at the Medicare expen…
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Ambidextrous strategy: PART 2 – Scenario Implications
By
Nikhil Bhojwani
Payers
,
Providers
In our last post we introduced two potential scenarios.
"Provider bas…
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Ambidextrous strategy: PART 1 – Payer and provider strategy for two very different worlds
By
Nikhil Bhojwani
Payers
,
Providers
It seems like every day there’s some news outlining strategic actions …
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When do you know ACOs are here to stay?
By
Tory Wolff
Payers
,
Providers
Answer: When they form an industry association!
Back in February, a …
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Risk-taking providers in private exchanges: Medica’s “My Plan” private exchange
By
Tory Wolff
Payers
,
Providers
At a TEDMED conference a couple years ago, I had to write some sample …
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Getting the troubled Highmark-West Penn relationship back on track: an outside-in speculation
By
Tory Wolff
Payers
,
Providers
Summary
Highmark and the West Penn Allegheny Health System (WPAHS) ar…
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Clear Health Alliance: Debut of the for-profit HIV/AIDS special needs plan
By
James Matheson
Payers
Summary
HIV Special Needs Plans (SNPs) offer extra layers of servic…
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Rescuing the condition-focused ACO from CMS
By
James Matheson
Payers
,
Providers
Summary
The case for an oncology ACO can be compelling but CMS rule…
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Transitioning from patchwork to quilt: NY and PA’s path to integrating HIEs at the state level
By
James Matheson
Payers
,
Providers
Last month, NY and PA announced plans for how they will integrate data…
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Heartland Health: Marching towards Kansas City with Mayo on its shoulder
By
Tory Wolff
Payers
,
Providers
Earlier this month, Heartland Health signed a deal with the Mayo Clini…
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Payment reform: some observations on skepticism
By
Tory Wolff
Payers
There have been some blog posts (here and here) about a discussion on …
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Lumeris, NaviNet and the emerging battle for cloud-based ACO enablement
By
Tory Wolff
Payers
,
Providers
Summary
Administrative clearinghouse NaviNet has been acquired by 3 B…
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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 –…
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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…
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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…
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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…
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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…
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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…
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ACO profitability: Reasons for optimism
By
Tory Wolff
Payers
Summary
A new article in the NEJM suggests ACO economics will be unat…
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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…
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Revolution in Roanoke? Perspectives on the Aetna-Carilion deal
By
Tory Wolff
Payers
,
Providers
Summary
The line between health plan and provider continues to …
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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 …
