News & Commentary
The Congressional Budget Office in 2010 projected that enrollment in Medicare Advantage (MA) would decline from 10.9 million (or 24% of total of Medicare enrollment) to 8.2 million (14% of total) by 2015. Instead, MA enrollment grew to 17.8 million in 2015, about a third of all Medicare enrollees.

John Molina, the CFO of Molina Healthcare, faced intense questioning yesterday from a Justice Department lawyer concerning the proposed $34 billion merger of Aetna and Humana.

Six months can make all the difference for a company that wants to put a biosimilar on the market.

News & Commentary

Virginia A. Moyer

Dismayed by Mylan’s moves to have its EpiPen classified as a preventive service, three former leaders of the U.S. Preventive Services Task Force (USPSTF) argue in a recent issue of the Annals of Internal Medicine that maybe it’s time to cut the ties between the task force’s advice and insurance coverage.

In bygone says, legislators like Democratic Sen. Henry “Scoop” Jackson and Republican Sen. Robert Dole could hammer out deals, and move legislation along. That cooperation has been lost in recent decades, but perhaps not forever.

Talk about the fox guarding the henhouse. Libertarian Jim O’Neill is not much known in, as the president-elect would call it, “the swamp”—that is, among the powerful in Washington.

News & Commentary
Physicians don’t think highly about the ability of electronic health records (EHRs) to support clinical outcomes, according to Deloitte’s “2016 Survey of U.S. Physicians.” Less than half (47%) of physicians agree that EHR capabilities improve clinical outcomes. That’s down from the 2014 survey, in which 55% of physicians believed the same.

The ACA’s troubles of late have been well-documented: two of the largest insurers, UnitedHealthcare and Aetna, leaving the exchanges because they’ve lost hundreds of millions of dollars; an inability to encourage younger, healthier people to join and thereby broaden the risk pool; and the sharp h

Sepsis contributes to nearly half of hospital deaths in the United States, and now a drug company wants to try something new against this deadly infection of the blood: cutting-edge cancer immunotherapies, STAT reports.

Original Research
Sze-jung Wu, PhD
Qinli Ma, PhD
Patricia Martin, RN, BSN
Andrea DeVries, PhD
Value-based centers of excellence programs offer an advance over programs that focus only on cost or quality alone in the ability to identify facilities with lower costs and equal or better quality outcomes. Value designation offers patients transparency for selecting care providers.

More trouble for the ACA marketplace: Consumers are having a difficult time finding doctors because the lists offered are inaccurate, Kaiser Health News reports. This is occurring despite new federal rules designed to guarantee reliable physician directories.  

Had your fill of the courtroom drama surrounding the proposed merger of Anthem and Cigna? Well, now it’s time for the drama surrounding the proposed merger of Aetna and Humana, another instance where the Justice Department charges that such a move violates antitrust law.

MediMedia Research Survey
Respondents to the survey of medical directors and chief medical directors officers rated their organization’s commitment to value-based care as high, a development that will mean grappling with the cost implications of clinical policies and practices. A third said a large percentage (41% or higher) of their job concerns the financial performance of their organization.

The brouhaha generated by Turing Pharmaceuticals and Valeant Pharmaceuticals this year because they jacked up some older medicines they’d purchased to head-line grabbing heights may have provided cover for the rest of the industry, according to Leonard Schleifer, MD, the head of Regeneron Pharmac

Medical Director Profiles
Howard Wolinsky

Neal Kaufman, MD

“My job as CMO is to make sure we’re keeping the patient at the center—that our products make sense to them and to clinicians,” he says. Canary’s programs come from protocols that have been vetted by scientists, clinicians, and patients over many years, if not decades.
Medical Director Profiles
Howard Wolinsky

Steve Miller, MD

“Some days I’m out supporting our sales people and trying to acquire new business. Some days I’m with our legal teams trying to help them decipher new regulations. Some days I am with our supply team group negotiating with the pharmaceutical companies.”