The pursuit of value with risk models

Matt Siegel, Verisk Health

The proliferation and variety of accountable care designs in commercial insurance, Medicare Advantage and managed Medicaid highlight the need predict the appropriate cost of care, ensure access to needed services and raise quality. But how can value be measured?

Will stricter controls on painkillers curb abuse and addiction?

G Caleb Alexander, Kevin Fain, Matthew Daubresse

Americans consume a staggering amount of the opioid painkiller hydrocodone, about 99 percent of the world's supply. In October, after 10 years of debate the Drug Enforcement Agency (DEA) reclassified medications like Vicodin, and products that combine hydrocodone with other drugs, as Schedule II controlled substances.

Feature Video

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.


Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

Federal health officials and state exchange leaders may be pleased with enrollment and plan choices in many places, but long-term financing is a puzzle yet to be solved.

California's experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.

Want to pay your health plan premiums while picking up medications, buying some batteries (or maybe a piece of chocolate) and getting a free cholesterol screening? Humana is betting that retail convenience will support its individual membership business.

A new payer-led patient information exchange in California is getting ready to hit the ground running.

One of the greatest concerns among patient advocates, regulators and insurers alike is that buying and using a health plan may be too complex a task for some consumers. One state exchange is hoping it found a scalable solution.

Americans working to improve their eating and activity habits often fail, and not for lack of investment by employers, insurers and wellness vendors. Despite, or perhaps because of those challenges, Cigna is taking another crack at the problem.

The nation's highest rated health plan is going through some growing pains and trying to make it to 2015 intact.

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