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Editorials

The quest for a single source of terminology truth

Tom Winchell, Dean Health

As federal regulatory initiatives up the ante on information sharing capabilities inside and outside a healthcare organization, the C-Suite is increasingly finding that a comprehensive terminology management strategy is critical.

Cancer drugs: Why the high and rising prices?

David Williams

When Americans talk, pharmaceutical companies listen. And what they’ve heard is that initiatives to contain or regulate medical costs get labeled as “rationing,” a word with very un-American connotations.

As government-funded managed care booms, the bar is rising

John Gorman, Gorman Health Group

We are now in the Golden Age of government-sponsored health programs, and the opportunities and challenges that come with this shift have never been greater.

Benefit design and the rush, hush and crush cycles

Ajanthan Balasinkam, Milliman

Employer health plans have seen significant benefit design changes in the past few years, due to rising healthcare costs and the Affordable Care Act. As actuaries analyze historical medical cost trend in order to forecast future trends and analyze the impact of benefit design changes, the effect of the member behavioral phenomena known as "benefit rush," "benefit hush" and "trend crush" should be considered.

Health plan complexity brings claims payment integrity challenges

Paul Vosters, Discovery Health Partners

In their ongoing efforts to manage costs and improve profits, many health plans are turning to the area of claims payment integrity, seeking opportunities to reduce annual claims expense by millions of dollars.

Individual open enrollment: What will normal look like?

Tim Ferguson and Darla Leseck

Moving beyond the 2014 "land grab," insurers in 2015 relied upon tried and true direct marketing approaches for member acquisition. Like the first open enrollment period, it seems for many, this was effective.

Planning for consolidation: The impact of health system consolidation on health plans

Sonal Kathuria and Ollie McCoy, Deloitte

Consolidation is a fact of life in American business. In fact, some of our biggest industriesbanking, retail stores, airlineshave been fundamentally reshaped by consolidation and the application of more competitive business models.

The Obamacare dichotomy: HIXs struggle as incomes increase

Robert Laszewski

We don't need to put more emphasis on the penalties for not buying health plans; we need attractive insurance products people want to buy.

Cost of a cure: A surge unlike anything Part D has seen

Charles Ornstein, ProPublica

Medicare spent $4.5 billion last year on new, pricey medications that cure the liver disease hepatitis C, more than 15 times what it spent the year before on older treatments for the disease.

Medicaid expansion means a richer QHP buyer pool on exchanges

Andrew Sprung

In my close look at silver plan selection in 2015 among HealthCare.gov customers who were eligible for Cost Sharing Reduction (available only with silver plans), I expressed some disappointment that CSR takeup had apparently dipped a bit on the federal exchange from 2014 to 2015. Disappointment on that particular point may have been misplaced.

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