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...
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 request to take steps towards their mother but only taking steps if their mother allows it! While it would be strange...
3rd Annual ACA Consumer Value State Rankings
The story of consumer value in the Affordable Care Act (ACA) individual marketplaces echoes one of the great epochs of our nation’s history where a sense of manifest destiny culminated in a quest to unite the coasts...
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 CMS Office of the actuary show that US health care is pushing towards a 20% share of overall GDP, an all-time record...
A Provider’s Primer for Shared Savings Arrangements
Shared savings arrangements have increased in popularity as healthcare shifts towards value-based care. In its most basic form, the total healthcare costs of members associated (i.e., or those attributed)...
Value-Based Care’s Impact on Healthcare Mergers & Acquisitions
Provider reimbursement models are evolving as the healthcare system attempts to combat rapidly rising healthcare costs. A major development has been the push towards value-based care (VBC). Value-based payment
COVID Christmas Gifts
As we sit here in December 2021 COVID is still active and cases appear to be climbing in certain pockets of the United States. In early 2020, when the pandemic began, few of us ever thought that we would be dealing with...
Impressions of the ACA: The 1st Year of the 2nd Decade
I cannot help myself. To celebrate the 10th anniversary of the Affordable Care Act (ACA) last year, I wrote about 30 influential voices in the ACA’s first decade. At the end, I surmised the article probably deserved a reprisal...
Targeting Clarity Through Transparency
Over the years much has been said about the issue of increasing costs of healthcare, its causes, and solutions to address it. In terms of solutions, on one side of the spectrum is the constant drum of a government takeover...
Geographic Utilization Disparities and Financial Impacts
It seems natural to assume that the scientific underpinning of medicine implies a formulaic treatment for any given combination of presenting symptoms. However, this assertion ignores the artistic nature of care management...