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 [...]
The Financial Impact of Biosimilars
Introduction There is a coming wave of changes arriving soon to the pharmacy market in the form [...]
Provider Contracting Trends – Déjà vu All Over Again
Introduction About 30 years ago I met with my then-business partner to think into the future and [...]
The Big Event: Humira Biosimilar Launches
Introduction Today is the day! The Big Event of 2023 is the launch of multiple Humira biosimilars [...]
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 [...]
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, [...]
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 [...]