Plan Design Survey of the 2023 Individual Market
The macroeconomic environment is radically shifting as inflation ratchets up costs in every consumer category, including health care. [...]
Intelligent Capitation Rates – Strategically Aligning Risk Adjustment with Costs
Introduction Aligning capitation rates with the line of business and risk selection of attributed members is an [...]
Time to Talk About Trend
There have been a number of market-changing dynamics over the last few years affecting healthcare with COVID [...]
My Recent Experience with Kaiser Health System
I moved from the east coast to the west coast seven years ago. My employer had several options [...]
Utilization Profiling for Care Management (and Profitability!)
Although there are many variables influencing healthcare costs, the most important are unit cost and utilization. Unit cost [...]
Pharmacy Provisions of the Inflation Reduction Act
Introduction I read the 725-page draft of the Deficit Reduction Act[1] so you don’t have to. Well, [...]
New Provider Negotiation Dynamics
In a recent Inspire article, Are We In For Significant Healthcare Cost Increases?, David Axene explained why [...]
Mother May I? Interpreting ACA Pricing Allowances
“Mother-May-I” is a classic kids’ game that teaches little ones to honor their mother by having players [...]
3rd Annual ACA Consumer Value State Rankings
The story of consumer value in the Affordable Care Act (ACA) individual marketplaces echoes one of the [...]
Are We In For Some Significant Health Cost Increases?
Health care costs continue to increase faster than the rest of the economy. Recent projections by the [...]