Payers

Commercial insurers, the employer and individual market, plus Medicare trends, Medicare Advantage, & Medicaid managed care

Payers' Playbook
Joseph Burns
A Rand report showing that some hospitals charge 200% to 300% more than Medicare pays has sparked a new effort among employers to push hospitals to cut what they charge for care. Hospital leaders say price is only part of the story.
Feature
Susan Ladika
Insurers say opening up clinics in drugstores will make health care more convenient, more timely—and potentially less costly. But will it also bring unwanted commercialization and fragmentation?
Cover Story
Timothy Kelley
Do you enjoy threading a needle while trampolining? Teaching Greek to resistant learners when you’ve only had a quick Berlitz course yourself? If so, health care consulting ought to be a breeze, as you doubtless possess the flexibility, ingenuity, and tact it requires—together, let’s hope, with…
Cover Story
Timothy Kelley
You can’t know everything, and neither can your staff. Bringing in outside expertise can be a godsend for health systems, health plans, pharma manufacturers, or governments—if they use it properly. Trouble is, that’s a big “if.”
Susan Ladika
Health insurers are taking a lot of heat these days for this country’s extraordinarily high health care costs and the many ways those costs are burdening American families. A report by UnitedHealth Group last month attempts to change the subject to specialty drugs and how site-of-service change could…
Susan Ladika
Competition in the health insurance market continues to fade with more markets dominated by one or two companies, according to a study by the American Medical Association. But a Robert Wood Johnson Foundation report suggests that the market for the ACA exchange plans may be an exception to trend toward…
Frank Diamond
The rate of increase of health care costs was less over eight years for beneficiaries enrolled in a value-based program in which participating physicians took on two-sided risk, compared with a control group seen by providers with traditional contracts, according to a study published in the New England…
Cover Story
Joseph Burns
Rebates have created pay-to-play dynamics. Employers facing high drug costs have “rebate addiction.” And the impressive “rebate guarantees” are hard to resist. But at least the process of how drugs get formulary placement is becoming clearer, and some PBMs have moved to charging administrative fees only.

A blueprint for high-volume, high-quality lung cancer screening that is detecting cancer earlier—and helping to save lives

Clinical Brief

Multiple Sclerosis: New Perspectives on the Patient Journey–2019 Update
Summary of an Actuarial Analysis and Report