News & Commentary
Frank Diamond
Viewpoint
Thomas Martin
News & Commentary
Peter Wehrwein

A 2017 Kaiser Family Foundation report says that Medicare Advantage beneficiaries have fewer physicians to choose from. But a study published in the April 2019 issue of Health Affairs paints a drastically different picture of MA plan networks—one that upends that prevailing wisdom.

Jan Greene
New federal regulations are pushing for interoperability, but insurers say the 2020 deadlines are unrealistic.
Viewpoint
Dea Belazi
PBMs can play an important role in the pharmaceutical supply chain and are positioned to protect consumers and save them out-of-pocket costs. The emergence of new PBMs, whether inside or outside an insurer, should drive new solutions and the development of new models.
News & Commentary
Frank Diamond
In what’s being hailed as the first organized effort to standardize how social determinants of health data are collected, processed, and used for patient care, nearly two dozen new ICD-10 codes related to SDOH have been created through a collaborative effort by UnitedHealthcare and the AMA.
CURRENT ISSUE May 2019

Somebody Turn on the Lights

Uwe Reinhardt died in 2017 but the famous health care economist’s advice lives on. His book, Priced Out: The Economic and Ethical Costs of American Health Care, is out. What a coincidence. Our cover story takes on the maddening opacity of health care costs. The deck on our cover plays on one of the main points we took from our 2013 Q&A with Reinhardt: “Why nobody knows what anything costs in health care and what can be done about it.” In February, Senior Contributing Editor Timothy Kelley wrote the must-read article about Medicare Advantage. He may have done the same with this intransigent problem.

UPCOMING MEETINGS

Chicago, IL
June 05-06, 2019
Rutgers School of Pharmacy, New Brunswick, NJ
June 11, 2019
New Orleans, LA
June 13-14, 2019
New Orleans, LA
June 13-14, 2019
Newport, RI
July 10-12, 2019
Washington, DC
July 16-17, 2019
Philadelphia, PA
July 22-23, 2019
San Diego, CA
July 25-26, 2019
News & Commentary
Peter Wehrwein
CMS and its regulations are so instrumental in shaping American health care, a quality CMS podcast would be welcome. That’s not what we have in “CMS Beyond the Policy,” which seems to be more about pushing CMS Administrator Seema Verma’s policies—with the help of paid outside Republican consultants—than getting beyond them.
Our Yearlong Look: Emergency Care Examined
Joseph Burns
They are touted as an alternative to emergency departments. Private companies are seeing an opportunity. But are urgent care centers meeting a demand or creating one?
The contract between UPMC Health Plan and AstraZeneca will help the brand-name antiplatelet drug compete against generic versions of Plavix by lowering the copay to $10.
Peter Wehrwein
A study designed to test whether eliminating copays would improve adherence to antiplatelet therapy showed that, yes, indeed, it does. But the results also showed no reduction in major cardiovascular events among those who stuck with the medication.