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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 economy. Much [...]
Pharmacy Provisions of the Inflation Reduction Act
Introduction I read the 725-page draft of the Deficit Reduction Act so you don’t have to. Well, I skimmed 427 pages of it while focusing on the 164 pages which make significant [...]
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 [...]
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 [...]
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% [...]