Biosimilars: The Coming Wave
There is a big wave of changes coming to the pharmacy market. The extent of the impact this wave will bring is not yet fully known, but there are trends we can follow that help predict what this change will look like...
Paying the Piper: How 2020 Could Make 2023 Even Tougher for Value-Based Care Providers
It’s widely predicted that 2023 will pose broad economic challenges. Reasons abound for a potential recession, but in many ways, it’s time to pay the piper for actions taken during COVID. That’s not to suggest no fiscal...
Biosimilars: A Brief Introduction
The coming market introduction of several significant biosimilars is predicted to bring a wave of change to the pharmacy benefits status quo. As healthcare consultants, we have been watching the swell develop and have put together this primer to help educate...
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. AHP has already written extensively on broader inflation’s impact on trend, painting...
Intelligent Capitation Rates – Strategically Aligning Risk Adjustment with Costs
Aligning capitation rates with the line of business and risk selection of attributed members is an important component of provider contracting. Furthermore, doing so can illuminate hidden dynamics in financial...
Time to Talk About Trend
There have been a number of market-changing dynamics over the last few years affecting healthcare with COVID unsurprisingly being the most notable. There was a steep decline in healthcare utilization in...
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 to choose from for my healthcare benefits. In addition to options with national insurers, such as...
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 is subject to many constraints in relation to both healthcare and the broader...
Pharmacy Provisions of the Inflation Reduction Act
I read the 725-page draft of the Deficit Reduction Act[1] so you don’t have to. Well, I skimmed 427 pages of it while focusing on the 164 pages which make significant changes to prescription drugs. This article outlines...
New Provider Negotiation Dynamics
In a recent Inspire article, Are We In For Significant Healthcare Cost Increases?, David Axene explained why healthcare cost trends may soon accelerate. This article explores one of the drivers for that...