- Hypertrophic Cardiomyopathy (HCM)
- Vaccines: 2023 Year in Review
- Eyecare
- Urothelial Carcinoma
- Women's Health
- Hemophilia
- Heart Failure
- Vaccines
- Neonatal Care
- NSCLC
- Type II Inflammation
- Substance Use Disorder
- Gene Therapy
- Lung Cancer
- Spinal Muscular Atrophy
- HIV
- Post-Acute Care
- Liver Disease
- Pulmonary Arterial Hypertension
- Biologics
- Asthma
- Atrial Fibrillation
- Type I Diabetes
- RSV
- COVID-19
- Cardiovascular Diseases
- Breast Cancer
- Prescription Digital Therapeutics
- Reproductive Health
- The Improving Patient Access Podcast
- Blood Cancer
- Ulcerative Colitis
- Respiratory Conditions
- Multiple Sclerosis
- Digital Health
- Population Health
- Sleep Disorders
- Biosimilars
- Plaque Psoriasis
- Leukemia and Lymphoma
- Oncology
- Pediatrics
- Urology
- Obstetrics-Gynecology & Women's Health
- Opioids
- Solid Tumors
- Autoimmune Diseases
- Dermatology
- Diabetes
- Mental Health
Plans ready to bet on exchanges, some states dragging their feet
As the motivation for implementing health exchange increases, some states have made little progress.
NATIONAL REPORTS - As the motivation for implementing health exchanges increases, some states have made little progress. And that doesn't bode well for plans that are eager to start crafting new products.
"The smart money now would say that exchanges in one form or another will be up in each state on the current time table," says Paul Lambdin, director, Deloitte Consulting LLP, who follows health exchanges. "A bet on a delay is just that-a bet."
Even though plans are eager for exchanges to reach the market, most are trying to build their strategies with little guidance from states.
According to Birhanzel, plans that focus on a single market or a few geographical areas have the ability to tailor offerings to what the particular states are building. If plans aren't entirely sure what states are building, they can at least follow the known exchange policies and tweak as needed. Large national plans face a bigger challenge.
"They're going to face probably almost every flavor of those different [state model] options," says Birhanzel.
He says it's important for plans to think in terms of an 80/20 rule. That is, 80% of requirements are likely to be common across states. Plans can begin to build capabilities based on that 80%, knowing that the 20% could vary greatly state by state.
"The challenge is to not only show up, but to be positioned to win," says Lambdin. "The two biggest challenges will be getting to the right price point and dealing with an individual consumer effectively and efficiently."
Lambdin says that plans' readiness for exchanges applies across three pillars:
Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
Read More
In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.
Listen
Doing More and Saving More with Primary in Home Care
September 1st 2021In this week’s episode of Tuning In to the C-Suite podcast, MHE Associate Editor Briana Contreras interviewed VillageMD’s Senior Medical Director of Village Medical at Home, Dr. Tom Cornwell. Dr. Cornwell discussed the main benefits of primary care at home, which includes the benefit of cost savings for patients, maintaining control of hospital readmissions and others. Dr. Cornwell also noted what has changed in the industry of at-home care and if there has been interest from payers like insurance companies and medicare in the service.
Listen
