Payers

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

Joseph Burns
In 2020, eight companies in the National Drug Purchasing Coalition hope to change how PBMs do business.
The Future of Managed Care
Joseph Burns
As genetic testing gets more costly and complex, health plans call on yet another intermediary for help in curbing excessive utilization. But is adding a new middleman really the answer?
The Future of Managed Care
Timothy Kelley
Managed care can survive and may even thrive, experts say. But that will be in a world where public payers loom larger, provider prices are pushed down, the wellsprings of illness are addressed, and consumers aren’t quite so frustrated and angry.
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…

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