MedPartners, the beleaguered physician practice management company, named Mac Crawford president and CEO. Crawford had been chairman and CEO of Magellan Health Services, one of the country's largest specialty managed care organizations. MedPartners also announced that it finished 1997 with a net loss of $821 million, compared with a net loss of $146 million in 1996. MedPartners is in the process of closing 84 clinics, affecting 238 physicians.... Speaking of the CEO shuffle, Stephen Wiggins departed Oxford Health Plans, the company he founded in 1984, with a $9 million severance package, according to company filings. Wiggins left Oxford in February, a result of the HMO's financial and operational problems. The New York attorney general's office is trying to prevent Wiggins from getting the entire package.... The doctors who owned Physician Healthcare Plan of New Jersey sold their 80,000-member HMO to Blue Cross Blue Shield of New Jersey. Today's market makes it nearly impossible to compete against the big players, said Joseph Billotti, M.D., the HMO's former chairman.... The National Committee for Quality Assurance put two new performance measures in the 1999 version of the Health Plan Employer Information and Data Set: cholesterol management after acute cardiovascular events and antidepressant management. In addition, performance on HEDIS measures will count toward a plan's accreditation score beginning July 1, 1999.... The Agency for Health Care Policy and Research is inviting submission of clinical practice guidelines for inclusion in its National Guidelines Clearinghouse, which goes online late this year. Guidelines must have been developed under the auspices of medical specialty associations or professional societies, government agencies, health plans or public or private organizations to be considered for inclusion.... The American College of Physicians has approved a merger with the American Society of Internal Medicine. The merger takes effect July 1, with the combined ACP-ASIM to be headquartered in Philadelphia, ACP's current home. The combined group will have 120,000 members.
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.