Health Insurance

American Healthcare was a finalist for the NIHCM Digital Media award in 2015. The blog ran from 2013- 2019, with syndication to Tincture, KevinMD and The Health Care Blog. This is an archive of the blog posts: images and formatting are unfortunately lost. Since these posts are pretty old, some of my thoughts have evolved, and some data is no longer accurate...

Apr 28, 2016

Hospitals are Pigging Out on Commercial Reimbursement and Starving on Medicare. What's Next?

The Spring 2016 Medpac report on Medicare payments is out. This annual report to Congress (put together by the 17 members of the...

Jan 3, 2016

Healthcare's Friendly Societies: What Would a Healthcare Mutual Look Like?

For a few years I've been fantasizing about what a healthcare insurance/ delivery mutual would look like . I've yet to see one but I...

Dec 1, 2015

Express Scripts Undoes Turing Pharmaceuticals: Witness the Rise of the "Activist" PBM

Everyone knows the recent story of "rapscallion" Martin Shkreli : the ethically depleted CEO of Turing Pharmaceuticals who bought the...

May 4, 2015

Why Value Generation Doesn't Grow Your Risk-Bearing Medical Group: On Being Foiled by the Middleman

Imagine that you are an electronics manufacturer who has figured out how to build a superb stereo system at a far lower cost (20% less)...

Feb 27, 2015

Global Capitation: The Three Less-Obvious Vulnerabilities for Health Systems Considering Global Payments

I receive a fair number of emails and Linkedin messages from healthcare executives who are interested in global risk contracts and are...

Dec 30, 2014

Pricing Risk: What Margin Should Risk-Bearing Healthsystems Reasonably Expect?

There is an old adage in the business world: reward follows risk . In other words, in an ideal market, investors are supposed to balance...

Nov 21, 2014

Empowering Patients to be Better Insurance Shoppers: Should We Offer "Name Your Price" Health Insurance?

Anyone who watches a lot of TV has likely seen Flo, the energetic Progressive Insurance spokeswoman. Flo spends a lot of time...

Jun 8, 2014

Another Domino Starting to Fall- The Narrowing of Physician Networks

In previous posts , I've discussed the inevitable squeeze that high cost/ low quality physicians will feel from payers as the system...

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