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Editorials

Grey areas: When waste becomes fraud

David Jackson, Verisk Health

The challenge that health plans face is that within the spectrum of fraud, waste and abuse, it can be unclear if a billing mistake is accidental or intentional.

Why insurance CIOs are moving to a digital source of truth

Cathy Chiang, HighRoads

Never before has the need been stronger to ensure product and plan configuration is leveraged across the enterprise, from upstream activities like product strategy and sales to downstream processes like claims management.

Bertolini's strategic wage moves and preventive disruption

Jon R. Katzenbach, Gretchen Anderson and Art Kleiner

Perhaps the most visible wage hike by a chief executive in a century, Aetna's hourly raises are part of an audacious effort to not only profit in the new healthcare economy but influence its course.

You get what you pay for

Michael Wasserman, MD

The government continues to seek complex payment methodologies, which often involve problematic incentives to improve the existing system. Therein lies the problem.

Of course emergency visits are increasing

David Williams

As it happens with insurance, the emergency department utilization issue is pretty simple.

Business and IT challenges in value-based reimbursement

Deanne Primozic Kasim, IDC Health Insights

Payers need to be focused on the development networks that are not just narrow, but offer both consumer choice and a shared value reimbursement.

ACA customer satisfaction: It's the prices

Andrew Sprung

J.D. Power's health insurance satisfaction survey finds that customers who bought private insurance plans on ACA exchanges expressed slightly higher average satisfaction than people in employer-sponsored plans: 696 to 679 on a 1000-point scale.

Lemons and lemonade: GOP may extend subsidies, with lots of conditions

Robert Laszewski

The Republicans should offer an unconditional subsidy extension if the Supreme Court strikes them down.

The next bend in the cost curve: Rising prices for proven drugs?

Paul Levy

"The expense of the surgical robot will pale in comparison to the coming tsunami of overpriced drugs."

Financial services shows the way for healthcare (again)

David Williams

Seven hundred million people worldwide have obtained access to financial services for the first time over the past three years, according to a Gates Foundation funded institute.

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