Sometimes images just stick with you like the tune that you can’t get out your head. After editing our cover story this month about insurance company mergers by Susan Ladika, the image I can’t get out of mind is a pair of sumo wrestlers going at it. Susan interviewed Tim Greaney, a professor at St. Louis University School of Law, and Greaney compared the current consolidation of both providers and payers to the Japanese wrestlers. The law professor says as one side gets larger, it can counteract the market power of the other side. I wonder if the CEOs of these big-and-getting-bigger provider and payer organizations would agree to settle their disputes in a dohyo instead of at the negotiating table, wearing mawashis instead of expensive suits.
But I’ve also had a nagging feeling that the sumo wrestler analogy is off because, as Susan reports, the insurance mergers are partly a response to the growing role of the government payer. About 1 in 3 Americans now get their health insurance through a public health plan of some kind. CMS actuaries predict that federal, state, and local government dollars will finance nearly half (47%) of national health care spending by 2024 because of the ACA and baby boomers aging into Medicare. The plot thickens, though. An increasing share of those public dollars are managed by private entities. The trend lines for Medicare Advantage and Medicaid managed care plans continue to go up and up.
So maybe it’s not really private payers grappling with private providers, sumo-style, but a complicated cage match of government, employer, and personal funds, managed by private companies, going to larger providers. Let’s just hope the health and well-being of the American people emerges the winner.
More from the Editors Desk
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.
Yehuda Handelsman, MD
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.
RWE is a relatively new kid on the block. How exactly it will fit into the complicated world of cancer drug testing, approval, regulation, and marketing is uncertain. The randomized clinical trial has been the gold standard in oncology research for decades and will remain so for the foreseeable future.
American Telemedicine Association
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.
The FDA has given the green light to abaloparatide subcutaneous injection (Tymlos, Radius Health) for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed on or are intolerant of other available osteoporosis therapy.
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.