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Editorials

CEO pay ratio rule, inequality debate could pressure healthcare

Anthony Brino

Though still a major source of middle class jobs, healthcare companies, including consolidating insurers and nonprofits, may need to find a way to afford raises for their lowest-paid employees.

Praluent is not like Sovaldi

David Williams

A few reasons why the want-to-be cholesterol blockbuster Praluent will not be as much of a “budget buster” as the medicine that cures most hepatitis C patients.

The less you know about health insurance, the harder it is to choose the right plan

Mary Politi, Washington University

Picking the right insurance plans for your budget and health needs is challenging. Weighing monthly premiums and co-pays against yearly deductibles and comparing the benefits different plans offer can make your head spin, especially if you are newly insured.

Making sense of new risk adjustment filtering logic

Sean Creighton, Verisk Health

CMS recently released the long awaited risk adjustment filtering logic for the Medicare Advantage Encounter Data Processing System, requesting comment by August 21. This logic is an important factor in the future of risk adjustment.

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.

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