Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Health Insurance' Category

How many people don’t have any health insurance options

Much of the news has claimed that the Affordable Care Act is a failure because individuals in many counties have few or even no health insurance options.  However, how many counties truly will have zero Obamacare exchange insurance options in 2018 ? The Kaiser Family Foundation reports that there are only 17 counties covering 9,595 […]

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Pandemic Bonds

The World Bank is trying to insure against one of the worst crises in the world: a pandemic.  The Economist reports that the World Bank: …has issued $425m in pandemic bonds to support its new Pandemic Emergency Financing Facility (PEF), which is intended to channel funding to countries facing a deadly disease.  The bonds cover […]

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Is VBID gaining a foothold?

The answer is maybe.  Value-based insurance design ties patient cost sharing to the notion of a treatment’s value.  Higher value treatments have lower cost sharing; lower value treatments have higher cost sharing.  The Incidental Economist writes: In his own practice, Dr. Fendrick feels as if standard insurance is working against him and his patients. “They are deeply […]

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Will Better Care deliver better care?

The Senate’s new health care bill, the Better Care Reconciliation Act of 2017, proposes a number of changes to the Affordable Care Act.  The Kaiser Family Foundation has a detailed breakdown of the bill and compares it with the Affordable Care Act that President Obama passed and the American Health Care Act that was proposed […]

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The Future of Oncology Treatment and Value Assessment

Value frameworks are all the rage of late.  But are payers really using them? According to my colleague Jeremy Schafer, the answer is yes.  From an article in Drug Topics: “Value assessment may become more important as the health-care market shifts to outcomes and value-based reimbursement models,” said Jeremy Schafer, PharmD, MBA, Senior Vice President […]

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Prior authorization and opioid abuse

An interesting article by Cochran et al. (2017) examines whether health plan prior authorization rules can help prevent opioid abuse.  The authors use Pennsylvania Medicaid data from 2010 to 2012.  The data included both fee-for-service and managed care enrollees. The authors measured opioid abuse based on diagnosis codes for opioid use disorder (304.0, 304.00, 304.01, […]

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Interpreting evidence on value

Value is the latest jargon to hit the health care sector.  One potential way value could manifest itself is through value-based insurance design (VBID).  Under VBID, patients would pay lower copayments for treatments that are highly effective and/or low cost would pay higher payments for treatments that have low effectiveness or high cost to the […]

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Small business in limbo and other health care stories

The ACA is here…for now.  The AHCA is dead…for now.  Where will the health insurance market be 1 year from now, let alone in 5 or 10 years?  These questions have not yet been answered and the uncertainty is especially taxing for small businesses, especially as their premiums have risen. Marketplace has an interesting story […]

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Why don’t people like the American Health Care Act?

There has been a lot of criticism of the Republican’s “repeal and replace” bill known as the American Health Care Act. The critiques are coming from both the left and the right. Let’s look at just one provision–the premium age bands–to better understand why both people on the left and right do not like the […]

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Avoiding unnecessary care: Does insurance coverage matter?

Consumer Reports‘ “Choosing Wisely” initiative aims to identify high-cost, low-value treatments that can often be avoided.  One question remains is why do providers still offer these services?  Do payer coverage policies or reimbursement rules affect these choices? A paper by Colla et al. (2017) attempts to answer that question.  The authors used commercial payer claims data […]

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