A report released this month by the House Ways and Means Committee is 100% correct: Large employers would save billions of dollars over the next decade by eliminating health coverage for their employers and instead paying a $2,000 per-employee penalty. But employee benefits consultants doubt many, if any, big employers will make such a bold move. Why? Employers have been voluntarily offering health benefits to employees since the end of World War II. And they continue to do so, despite the ever... Read more

UnitedHealth Group has been racking up acquisitions of Medicare Advantage (MA) plans, not to mention several contract awards that previously belonged to Blues plans. As one health care observer explains, larger plans like United are seeking to expand their presence nationally, to prepare for whatever happens with health reform. Read more

The cloud of uncertainty that hangs over the federal health reform law in the Supreme Court wasn’t about to dampen Jonathan Blum’s good mood when he announced that 27 organizations had signed up for the Medicare Shared Savings Program (MSSP) — with hundreds more waiting in the wings to join its ranks. Blum, CMS’s deputy administrator and director of its Center for Medicare, asserted during an April 10 conference call that the program was off to a “phenomenal” start. Read more

As early results continue to trickle in on ACO models improving quality and reducing costs, more times than not, the developer in question cites “embedded nurses” or “nurse case managers” as the linchpin for achieving these results. Nurses, they say, serve as extensions of the physician’s office, providing a significant communication link between the patient and physician. Dick Salmon, M.D., Cigna Corp.’s national medical director, says that nurses “made all the difference” in closing gaps in... Read more

Charles Kennedy, M.D., chief executive officer for accountable care solutions with Aetna, Inc., offered a few cautionary words about ACOs and technology at a recent conference sponsored by industry trade group America's Health Insurance Plans. “Technology has been thought to be a fundamental enabler of ACOs for a variety of reasons,” Kennedy said. Read more

There’s definitely no “one-size-fits-all” approach to ACO governance structures. As Phil Gaziano, M.D., CEO of Accountable Care Associates LLC (ACA), in Springfield, Mass., explains in an upcoming issue of ACO Business News “there definitely are a lot of different models. Read more

In the February issue of Inside Health Insurance Exchanges, I interview Joel Ario, who headed HHS’s Office of Health Insurance Exchanges until last September. Last month, he joined Manatt Health Solutions — a division of the law firm Manatt, Phelps & Phillips, LLP — as a managing director. This was his first in-depth interview on exchanges, and he had quite a bit to say on the topic. When it comes to insurance exchanges, by far the biggest complaint I hear is related to the snail-like pace... Read more