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Editorial

Messy ACO demonstrations may bring ripples, waves to MA

John Gorman, founder and chairman, Gorman Health Group

If you're a Medicare Advantage Plan with a Medicare ACO in your neighborhood, or worse in your network, start sleeping with one eye open.

Whining about thousand-dollar pills

David Williams

David Williams's picture

When I saw Paying for the Thousand-Dollar Pill, an anti-Sovaldi op-ed in the Wall Street Journal, it brought back memories from my childhood when I toured the FBI headquarters in Washington, DC. The tour guide started off by showing us a wall with pictures of the 10 most wanted fugitives in the country and asked for our help in tracking them down.

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.

Wanted: A chief executive to lead a 76-year-old insurance company through a jungle of regulatory challenges, legacy business upheaval and new competition.

Clinical integration and accountable care developments in greater Philadelphia are taking a novel turn, with one large insurer teaming up with a new multi-health system collaboration.

As payers continue to look for the best ways to cover cancer treatment, a new study is lending support to the argument for moving away from hospital inpatient settings.

An insurance industry veteran who managed one of the few well-functioning state exchanges in the first open enrollment period is taking a key federal post.

While more payers and providers are trying to pursue value-based reimbursement models, some insurers are finding themselves fighting back against questionable fee-for-service schemes.

The federal government's employee advocate is trying to draw a line in the sand for wellness programs, and raising questions about the value and legality of some employers' incentive-based cost containment strategies.

How much leeway do employers and insurers have in deciding whether they'll cover contraceptives without charge and in determining which methods make the cut? Not much, as it turns out, but that hasn't stopped some from trying.

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