Drug Price Negotiation Program
This is a follow-up to a prior Inspire Blog article[1] we posted and the first of three we’ll be posting now that more information, detail, and realities have come to pass; this post delves deeper...
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...
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...
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...
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...
The Financial Impact of Biosimilars
There is a coming wave of changes arriving soon to the pharmacy market in the form of biosimilars. And that coming wave has a big event in 2023: the launch of Humira biosimilars, which...
Provider Contracting Trends – Déjà vu All Over Again
About 30 years ago I met with my then-business partner to think into the future and try to anticipate what we might see in terms of changes in the healthcare system. The results of this challenging process were...
The Big Event: Humira Biosimilar Launches
Today is the day! The Big Event of 2023 is the launch of multiple Humira biosimilars which begins today with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita is the first step in the Big Event...
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...