Patient-Centered Formularies: Steps In The Right Direction, But Challenges Remain

That is the title of my latest blog post in Health Affairs with co-author Mark Linthicum.  The premise is as follows: CVS recently announced its new Transform Rheumatoid Arthritis Care initiative, which aims to reshape coverage of rheumatoid arthritis care through “value-based management strategies including outcomes based contracts and a new indication-based formulary for autoimmune…

Why would Walmart want to buy Humana?

Walmart is a mega-retailer.  Humana is a health insurer.  Yet Walmart is in talks to either partner with or outright purchase Humana.   Why would Walmart want to do this?  My By becoming a health care provider, Walmart’s image will improve. By becoming a health care provider, Walmart stores will get more traffic as people shop…

Obamacare premiums rose 32% in 2018

Between 2017 and 2018, premiums Obamacare health insurance plans plans rose by 32%.  To be more specific, the Urban Institute reports that: The national average increase was 32.0 percent for the lowest-priced silver plans and 19.1 percent for gold plans, but the increases varied by states…State changes in average lowest-priced silver premiums ranged from a 22.5…

Cigna-Express Scripts merger

Today, Cigna purchased Express Scripts for $52 billion.  This follows another mega-deal where CVS bought Aetna.  The integration of pharmacy benefit managers (PBMs) and insurers is nothing new.  Previously, many insurers managed their own pharmacy benefit.  However, as PBMs grew in size and were able to get larger discounts and rebates, in-house PBMs became less…

Does episode-based payment reduce cost?

That is the question that Carroll and co-authors try to answer in their latest NBER working paper (WP #23926).  They examine the Arkansas Health Care Payment Improvement Initiative (APII), which is a state-wide, multi-payer episode-based program.  Unlike most episode-based payment (EBP) models, provider participation  in the program was mandatory (as of 2013).  NBER summarizes the program…

Medicaid and paperwork

When you buy a typical product, the vendor does its best to make the purchasing process as easy as possible.  There is a reason for this, clearly; they want your business.  State and federal governments, however, have no such incentive.  In fact, oftentimes reducing the number of people using government services saves money. Thus, it…

How did the Affordable Care Act affect the U.S. labor supply?

The Affordable Care Act (ACA) aimed to increase health insurance coverage largely through two pathways: (i) raising the income limits for individuals to qualify for Medicaid, (ii) creating new health insurance exchanges and health insurance subsidies to encourage the purchase of private health insurance among individuals that were not eligible for Medicaid.  Other provisions, such…