What is the “Value” in Value-Based Care?
In the ever-evolving landscape of healthcare, the terms "value-based reimbursement" and "value-based care" (VBC) have become buzzwords that signify a shift in how we approach...
Absence of Variation in Health Care
As we try to identify key causes of high US healthcare costs, the topic of variation, specifically variation in practice style, often emerges. It is an accepted fact that in manufacturing quality...
Plan Design Considerations for Self-Funded Employers
Unlike insurers whose plans must comply with strict metal tier and essential health benefit requirements, self-funded groups benefit from flexibility of plan design and offerings. However...
Thoughts on Kaiser Acquiring Geisinger
A former colleague came across an article I wrote last year, 'My Recent Experience with Kaiser Health System' – Axene Health Partners, LLC. After reading the article, she reached out to ask my thoughts...
Biosimilars: Maximizing Adoption
To achieve savings benefits from the coming wave of biosimilars, biosimilars must be adopted by prescribers, members, and payers (through their formulary strategies). While previous...
It’s a Bird! It’s a Plane! No, Just Another Healthcare Disruptor!
As with many things in life, change is challenging, often undetected when it starts, many times mislabeled as an aberration, but always important. As John F. Kennedy once said...
Biosimilars: Payer Decision Making
Once the first Humira biosimilar, Amjevita, launched in the United States in January, payers needed to begin making decisions about coverage not only for Amjevita but for all the other Humira...
Health Insurer Capital: How Much Surplus Should a US Health Insurer Hold?
Health insurers are required to hold minimum levels of surplus each year. However, the exact amount a health insurer chooses to hold can vary significantly from one insurer to the next...
How Many Doctors Does It Take to Make a Healthcare System?
For a healthcare system to run efficiently there is a balance that needs to be found where there is adequate staffing to accommodate the needs of a population. Too much staffing and supply...
Three Reasons to Consult an Actuary
In the world of employee benefits, organizations and brokers often find themselves struggling to get a clear picture of the entire health benefits landscape. For self-funded groups, the challenge lies in managing...