Non-preferred drugs under fire

Charles Ornstein, ProPublica

Some insurers are being accused of violating the spirit of health reform, by forcing people with a variety of illnesses, including Parkinson's disease, diabetes and epilepsy, to pay more for their drugs.

Are payers using clinical data effectively enough?

Gokul Gangadharan, CitiusTech

With increasing regulatory pressure, payers are keen to adopt new technologies, improve efficiencies, implement analytics and build interoperable platforms, but are left looking for ways to access clinical data from providers and other caregivers. The challenge is often in getting a single, standard view of patient data and translating this data into actionable intelligence.

Consumer complexity, confusion to come in open enrollment

Robert Laszewski

It's been pretty quiet lately on the Obamcare front, but that is about to change. To say this fall's open-enrollment has the potential to be problematic is an understatement.

Keeping your wind in the final AEP laps

Debbie R. Mabari

Medicare plans are mid-way through the process of creating Annual Election Period (AEP) materials that are due to members by the end of September. At this stage of the game, tension is running high and time is running out.

Insurance coverage data a baseline for ACA impact

Richard Kronick, AHRQ

With more than 10 million Americans newly insured so far under the Affordable Care Act, enormous changes to insurance coverage in the individual and Medicaid markets are occurring. At the same time, major changes to rating practices in the small group market are also taking place, prompting concerns about the effect of the ACA on premiums for the large and small group markets.

Patient engagement paves the way to higher CMS star ratings

Mariza Hardin, vice president of government sector solutions, Alere Health, Inc.

Not only are older Americans living longer than in past generations, they also have multiple health problems, according to "The State of Aging and Health in America 2013" report by the Centers for Disease Control and Prevention (CDC).

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.

The digital advantage in attracting new members

Avneet Batra and David Magrini

The Affordable Care Act has given healthcare payers the opportunity to let Americans buy healthcare benefits in a whole new way: online. With a new open enrollment period right around the corner, the marketplace is changing how individuals think about and make healthcare insurance purchasing decisions.

OIG, GAO reports focus on HealthCare.gov operations

Debra McCurdy, Reed Smith Life Sciences Health Industry Group

The U.S. Department of Health & Human Services Office of Inspector General has issued two reports on implementation of the Affordable Care Act health insurance "marketplaces."

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.


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