Contributor: Jane Dubose
Topic: ACOs, Pioneer ACOs, Sharp HealthCare

It’s hard even for the most ardent of optimists to find many silver linings in the new data from the federal government on the financial and quality performance of Medicare accountable care organizations. Created by the 2010 Affordable Care Act, the Medicare ACO experiment has been widely seen as one of the most significant shifts in healthcare delivery in the last few decades. Read more.

Contributor: Jane Dubose
Topic: pharmacy benefits, copay coupons

Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business (the coupons are not allowed for Medicaid and Medicare). Now, it appears the limb broke, and the company has essentially decided to backtrack. Read more.

Contributor: Jane Dubose
Topic: Copay coupons, pharma benefits, exchanges

Let’s imagine two cars speeding toward one another – in one car are branded manufacturers keen on protecting valuable drug franchises, and on the other are payers equally keen on tamping down drug costs, particularly on new specialty medications. Read more.

Contributor: Jane Dubose
Topic: ACOs, Pioneers, CMS

For those ACO watchers who are in the glass-half-empty camp, there was plenty of spilled milk to absorb from the government’s preliminary report on the Medicare Pioneer and Shared Savings Programs released Jan. 30. Read more.

Contributor: Jane Dubose
Topic: Copay coupons, statins, adherence, exchanges

Pharmaceutical manufacturers have scored two recent wins related to their increasing use of discount coupons for branded drugs.
First, they will be allowed to offer the coupons to those enrolling in the new marketplaces. Second, a new study is one of the first to link coupon use to higher drug adherence, in this case, for patients using statins. Read more.

Contributor: Jane Dubose
Topic: Exchanges, ACA, Humana

Let’s assume the federal health marketplace website actually starts working efficiently, the state-run exchanges clean up their bugs, and every other star aligns for the successful launch of exchanges in 2014. Who will be the enrollment winners among health plans?
Read more.

Contributor: Jane Dubose
Topic: ACA, Exchanges, MCOs, HHS

After more than three years of legal challenges, political grandstanding, rulemaking and technology building, it’s almost show time for the public health benefits exchanges. In a matter of days, Americans will get their first look under the hood of one of the largest new programs ever undertaken by federal and state governments.

Read more.

Contributor: Jane Dubose
Topic: ACOs, physicians, hospitals, pay for performance

In the world of healthcare reimbursement news, July 16, 2013, was a pretty big day. For months, there was speculation about how the accountable care organizations serving Medicare beneficiaries would perform. When the news finally arrived, some called it mixed, but I’d definitely give the joint performance of the 32 Pioneer ACOs at least a C+ or better.

Read more.

Contributor: Jane Dubose
Topic: ACOs, fee-for-service, reimbursement reform

I would need fingers and toes to count the number of conferences I’ve attended where the key message was this: The growth of healthcare costs in the United States is unsustainable and we’ve got to move away from fee for service.

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Contributor: Jane Dubose
Topic: ACOs, preventive care

Preventive care is oversold. Accountable care has yet to be defined. And despite the slowdown in healthcare spending, it’s still likely to grow faster than the overall gross domestic product in the United States, and emerging economies such as China and Russia.

Read more.