CMS ACOs Must Change

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The Medicare Shared Savings Program (MSSP) is not achieving its intended results. As the first of several Accountable Care Organization (ACO) models implemented by CMS, the MSSP has the most participants and the most data for analysis. In fact, there are currently 561 MSSP ACOs delivering care to 10.5 million lives.  … Read More

In fact, our government does “negotiate” drug prices

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The cost of pharmaceuticals is often in the news. Sometimes the story revolves around price-gouging (think Tura Pharmaceuticals). Other times the story revolves around life-saving therapies that come at high costs (think Sovaldi and Harvoni). Sometimes the national conversation leads many people to ask “why doesn’t our government negotiate the price it … Read More

Buying Healthcare: Putting You In Charge

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Employer-supplied health insurance (ESI) is going away. The process of acquiring health insurance is rapidly changing in ways that will put you in charge of the purchasing decision. This represents a fundamental shift in the market, as individuals will be empowered to become the consumer of health plans, not just the … Read More

Are ACOs the Future of the Exchanges?

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Consider an ACO as a self-contained provider network. What better partner for a managed care company seeking to offer a policy for sale on the Exchanges? After all, the premium cost listed on the Exchange is one of the most important elements of the buying decision made by individual shoppers. So if an … Read More

Will King vs. Burwell Tear Down the Health Care Law?

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Quick answer: No…. King vs. Burwell is the case now before the Supreme Court, currently scheduled to be heard on March 4th, 2015. The Court will consider whether subsidies that help make premiums affordable for individuals are available in federally facilitated exchanges as well as the state-run exchanges. Currently 36 … Read More

Drug Copays Rise On the Exchanges

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AIS Health reported that drug copay levels for 2015 are rising significantly from 2014. When drug copays rise, it puts a higher cost sharing burden on patients in an effort to keep premiums affordable. Most  purchase decisions made by patients in the Exchanges are based on the monthly premium and yearly deductible displayed on the … Read More