Health Plan Business

From Health Plan Week - New moves by PBMs Express Scripts Holding Co. and CVS/caremark to stake out exclusionary formulary arrangements for managing the use of high-priced hepatitis C specialty drugs have health insurers measuring the impact of the deals, with an eye on how the competition may lower the cost for these treatments and others in the same class. One major carrier, Anthem Inc., on Jan. 8 joined the fray when it declared that favorable pricing and clinical differences led it to choose Gilead Sciences, Inc.’s Harvoni hep C drug as the primary treatment for its members. Read more

From The AIS Report on Blue Cross and Blue Shield Plans - Despite strong evidence that some women with early stage breast cancer can achieve the same results with a shorter course of treatment, many radiation oncologists haven’t changed their treatment regimens, according to the results of a study published Dec. 17 in the Journal of the American Medical Association (JAMA). The study — conducted by the University of Pennsylvania, Anthem, Inc. and its outcomes research subsidiary, HealthCore — is the first… Read more

Health Plan Business Blog

By Jill Brown - January 27, 2015
HackensackAlliance, a New Jersey accountable care organization participating in the Medicare Shared Savings Program (MSSP), spoke at a recent Premier, Inc.-sponsored webinar to outline how it earned shared savings of $5.27 million in the first program year. The ACO discussed a variety of...
By Patrick Connole - January 23, 2015
Narrow provider networks are a popular way for health plans to attract mostly individual market consumers, given the promise of lower premiums resulting from payer deals with providers to limit in-network options, thus goosing volumes for hospital systems. The theory seems to have prompted a trend...
By Patrick Connole - January 7, 2015
You have to go back before the Affordable Care Act became the most famous, or infamous, three words in health care to find the origins of an innovative new bundled payment pilot program that UnitedHealth Group’s UnitedHealthcare unit and the University of Texas MD Anderson Cancer Center unveiled in...

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