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Editorials

For ACA plan buyers, it's not the price, it's the price spread

Andrew Sprung

There's good news and bad news in this forecast by Avalere Health of average premium increases in 2016 for health plans sold on ACA exchanges.

The four biggest 'hidden' costs for health payers

Gregory Berg, AxisPoint Health

With millions of Americans joining the ranks of those with health insurance under the Affordable Care Act, payers need to become even more vigilant in controlling costs.

CMS hip and knee bundle a harbinger, not ultimate solution

David Lansky, PBGH

Medicare turns 50 years old this month and has recently given a nicely wrapped present to advocates for more healthcare dollar value: a better way to pay for hip and knee replacements in the form of bundled payments.

Time to break the rules of population health

Colin Hill, GNS Healthcare

Population health brought evidence-based medicine to the family doctor’s office, vastly improving the overall quality and consistency of care in this country, but in doing so, it forgot about the individuals who make up the population.

The specialty conundrum: Caps may raise costs, not lower them

David Williams

It used to require hundreds of thousands of patients taking a drug to make it blockbuster. But over the last decade drug companies have figured out that they can get to $1 billion in product sales with much smaller populations. The key: sky-high prices.

High administrative costs a symptom, not driver of high healthcare costs

Tom Valenti, Forthright Health

Administrative bloat may not be the main cost-driver, but the chronic disease problem won't be controlled until administrators, insurers, Medicare and Medicaid simply get out of the way of primary care physicians.

Leveraging the full power of the SBC

Sohail Malik, Elixir Technologies

There is little question that healthcare payers, like all healthcare organizations, have mounting challenges when it comes to meeting regulatory compliance standards developed to improve the security, clarity and transparency of healthcare insurance information.

Bundled pricing strategies and price variation

Brad Hill, RemitDATA

The conversation regarding rising healthcare costs in the U.S. continues to swell with tension and uncertainty. Why do U.S. healthcare costs continue to climb at rates far outpacing other industries?

Results are in: Reinsurance and risk adjustment

Dawn Carter, Edifecs

The seminal reporting period for Marketplace-participating plans has closed and the results are in. Where does the industry go from here?

For ACA marketplaces, the near-poor are the sweet spot

Andrew Sprung

Among the near-poor, the proportion of the newly insured who gain their insurance through the marketplace was likely to be particularly high.

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