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We asked the Managed Healthcare Executive editorial advisory board to identify the top healthcare challenge in 2015. Here's what they said.
Complying with new requirements and regulations.
"The top challenge was trying to deal with all the new government regulations related to healthcare, most notably, the new Medicaid and Medicare rules from the Affordable Care Act."- Perry Cohen, chief executive officer, The Pharmacy Group
Waiting for the Supreme Court ruling and dealing with rising pharmaceutical costs.
"For the first half of the year the biggest challenge was waiting for the Supreme Court to rule on the Affordable Care Act. For the second half of the year it was addressing the rising costs of pharmaceuticals."
- Joel Brill, MD, medical director for FAIR Health, Inc.
Dealing with the continued impact and growth of specialty drug spending on overall healthcare trends, particularly in areas like hepatitis C.
"Even the industry’s foremost experts failed to project the impact newer hepatitis C drug technologies would have on such trends."
- David Calabrese, vice president and chief pharmacy officer, OptumRx
Managing their businesses through the continued evolution of the Affordable Care Act.
"Executives were dealing with managing newly covered individuals, implementing more focused approaches to quality, and trying to inter-relate the various streams of new data from electronic health records and from the Centers for Medicare & Medicaid Services."
- Don Hall, principal of DeltaSigma, LLC
Increasing the quality of care while lowering costs.
"The Affordable Care Act helped nearly 25 million people get access to healthcare, many for the first time. But, the fact remains, America still spends more on healthcare than any other nation-approximately $8,500 per person; 50% more than other developed nations-but people are no healthier. Americans have a shorter life expectancy, higher rates of chronic disease like diabetes, and one of the world’s highest rates of infant mortality. While this challenge is formidable, we ... believe that by putting people at the center of everything we do, we can harness innovative partnerships and technology to make healthcare better and more affordable."- Daniel J. Hilferty, president and chief executive officer, Independence Blue Cross
Ensuring the sustainability of smaller health plans, especially those focused on low-income populations.
"Health plans working in the Medicaid space in 2015 were hit with a perfect storm of pay rates squeezed by states still getting their balance sheets back to health from the recession. And, the emergence of high-cost specialty drugs hit plans further-even in cases such as hepatitis C drugs which provided cures. Plans in Medicaid may not see the benefits of healthier members as they churn off the Medicaid rolls. It’s critical that rates for plans are actuarially sound and developed in a transparent manner."
- Margaret Murray, chief executive officer, Association for Community Affiliated Plans