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Recent topics have included:

  • Doug Jones and the ACA, Epic misses a White House meeting, and man caves for man-flu sufferers
  • CVS-Aetna deal may trigger merger mania, Johns Hopkins criticized for lack of asthma prevention, & Columbia sees free-ride future for all of its med students

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

Payers

Women’s Health
Lola Butcher
High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care.
Joseph Burns
A MedPage Today blog post suggests that they do. Industry veterans say they’re unaware of bonuses for denials but agree prior auth processes should be more transparent.
Vox medical directorae
Lola Butcher

They are all physicians. They all want to take care of people. But the chief medical officers at health plans and provider organizations often see the world through different lenses. Here, chief medical officers from both sides of the divide share their views.

Timothy Kelley
Medical directors have been around for a long time. Today, to reflect expanding duties, there’s a bewildering array of other titles too. Are we all agreed on what titles mean, then? No way. For example: Many executives who are called CMOs—or something else—are also taking on the new duties of value-based care.
Joseph Burns
The company has more than 15,000 employees—or about a third of the eligible employees in those four locations—enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
Jan Greene

Some health plans responded by making it easier to see an out-of-network doctor, get a new copy of an insurance card or replace prescriptions lost in the chaos. Insurers also set up telephone help lines and made it easier to get a referral to a specialist.

Harvard Pilgrim’s program gives rebates to beneficiaries if Repatha doesn’t help them avoid a heart attack or stroke. It’s just the latest in a growing number of outcomes-based pricing agreements in which an insurer can get a discount from a drugmaker if a drug doesn’t help patients as much as expected.
Did UnitedHealthcare’s risk adjustment department actually “turn on the gas,” as one executive put it, in an illegal effort to increase revenue? That’s the claim at the heart of two cases the federal Department of Justice brought this spring against the nation’s largest health insurer. The industry is watching closely.