Payers

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

Self-insurance
Jan Greene
Risk doesn’t faze companies as much as rising premiums, and stop-loss offers some financial protection from the outliers.
What’s Hidden in American Health Care
Timothy Kelley
Too often, the prices of health care services and drugs are cloaked in mystery. A growing consensus demands that patients be given a clearer sense, in advance, of what things will cost. But there are obstacles–and some people benefit from the present confusion.
Benefit innovation
Frank Diamond
Cigna–HealthSpring and Anthem expand their Medicare Advantage offerings to include such things as hot meals and transportation to providers.
Frank Diamond
UnitedHealthcare has ditched Silver Sneakers for something it says is better. Other insurers are sticking with it. Either way, wellness is looming large in the MA market.
The Payers’ Playbook
Joseph Burns
Seeking reduced costs, small businesses and sole proprietors will find AHPs tempting. The premiums are lower, but you get what you pay for, critics say.
Direct Contracting
Lola Butcher

In 1991, the world’s second richest man griped about health care costs. Today, Sam Walton’s Walmart empire is striking back with direct contracting. The retail giant is using centers-of-excellence contracts by which it pays high-value provider organizations to treat specific medical problems.

The Value Proposition: Direct Contracting
Lola Butcher

Unlike most payer–provider relationships, the parties took a go-slow approach. The plan was offered only to employees who worked in a subset of Walmart and Sam’s Club outlets and lived or worked near Emory providers, and Walmart did not set premium levels to incentivize workers to choose the Emory ACO.

2019 Year in Preview
Susan Ladika
Insurers are busy merging with retailers and providers in vertical integration deals after attempts at horizontal combinations hit antitrust roadblocks.