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Commercial insurers, the employer and individual market, plus Medicare trends, Medicare Advantage, & Medicaid managed care
Zachary Hafner
At last count, the pharmaceutical industry’s new product pipeline included more than 7,000 products in late-stage development, roughly half of which are deemed “specialty.” The reality is, our health care system is poorly equipped to address this issue head-on.
Michael D. Dalzell
The architects of Medical Episode Spending Allowance benefits are radically reframing coverage as allowances for episodes of care and have a plan for engaging members in making better choices.
Joseph Burns
The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review the entire medical record?
Frank Diamond
The CMO of Molina Healthcare of Utah grew up, let’s say, not rich. He says that and a varied background—including a stint in the Air Force—helps him deal with changing policies involving a challenging population.
Sarah Kwon
Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.
Interview by Peter Wehrwein
Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever.
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.