Harvard Pilgrim’s program gives rebates to beneficiaries if Repatha doesn’t help them avoid a heart attack or stroke. It’s just the latest in a growing number of outcomes-based pricing agreements in which an insurer can get a discount from a drugmaker if a drug doesn’t help patients as much as expected.
Price, 62, with pure white hair, rimless glasses, and an easy, slightly cherubic smile, comes across like a friendly, family doctor, not the ambitious, politically-minded orthopedic surgeon that he is. He calls the ACA “useless” because of the high deductibles.
The CEO and chairman of Aetna has a penchant for pulling headline-grabbing moves lately, including a high-profile departure from the industry’s leading trade association, America’s Health Insurance Plans, and an attempt to acquire another big-five insurer, Humana, then pulling out when the Justice Department opposed it.
The new head of the FDA might as well be starring alongside Tom Cruise in the latest installment of Mission Impossible. Since being named commissioner in May, Gottlieb has said he wants the FDA to speed the approval process for generic drugs, introduce competition to drive down prices, and get the opioid crisis under control.
The new head of CMS recently wrote the nation’s governors urging that Medicaid recipients be required to pay premiums, be charged for ER visits, and be encouraged to get jobs or job training. This “skin in the game” approach appeals to conservatives, though critics say it can depress participation among the poor.
Kaiser Permanente’s CEO says that if he were redesigning Kaiser from the ground up, he would begin with a technology platform, not with hospitals, and that “telehealth is going to be our future.” He sees a future in which consumers know their bodies at least as well as they know their cars.
As editor-in-chief of the increasingly influential Kaiser Health News, she hopes to push back against a health care system in which every sector seems rigged against the patient. She leads a staff of 25 editors and reporters that includes two deep-digging data whizzes.
The conservative voice of reason on American health care policy and a fellow at the American Enterprise Institute says that “It would be far preferable for the country to reach some stability around health policy that both parties bought into.”
The president and CEO of Chicago-based Health Care Service Corp. made tough decisions to raise premiums and narrow networks. But, at least for now, HCSC plans to stay in the ACA exchanges while other insurers are jumping ship.
This upbeat doctor-policymaker-entrepreneur sees opportunity where others see a federal policy train wreck these days. For instance, he’s pleased that both political parties seem to endorse a shift from fee-for-service to value-based care. However, continuing uncertainty about the individual market may chill new investment in that area for a while.
The ACO, a creature of the ACA that often gets confused with its progenitor, seems like it will survive—and maybe even thrive—in whatever healthscape emerges from the Republican anti-ACA push. But just what will happen to the various forms of the ACO that are now in place?
Tuberous sclerosis complex (TSC) is a rare genetic disorder affecting the brain and other vital organs with varying symptoms and severity among patients. This study developed and validated a risk model to identify patients with TSC using large databases of medical and pharmacy claims.