Our Latest Thinking

We are constantly scanning the health care market for new and interesting developments; then we write about them here. Check out our latest thinking.

Affordable Care Act

Dual Eligibles: Lessons Learned & Future Implications

June 28th, 2017

Dual-eligible enrollees account for a disproportionately sizeable proportion of spending in both Medicare and Medicaid programs. However, until recently, these nearly 11.5 million[i] enrollees have not been in the spotlight in discussions regarding the move toward value-based payments.

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The Future of Medicaid

May 1st, 2017

The Affordable Care Act turned Medicaid into America’s largest public health care coverage program. While the volume associated with this growing program created increasing opportunities for providers, health systems, health plans, and vendors, these same stakeholders shouldn’t write off opportunities in Medicaid now simply because of the change in direction at the federal level. Instead, […]

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Charlie Brown, Lucy, and Risk Corridor Payments

February 17th, 2017

On October 13, 2015, your humble blogger received the AIS Inside Health Insurance Exchange quote of the day related to non-payment of the Risk Corridor payments, “…. there was a contract going into this that there would be certain protections… and plans would price as best as they could, knowing that there was no actuarial precedent for the risk. The news that CMS could pay carriers 12 cents for every dollar requested for the first year of the risk corridor program felt like Lucy moving the football at the last second.”

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State-Based Health Care Innovation: What Flexibility Exists Under Section 1115 and 1332 Waiver Opportunities?

January 31st, 2017

While a significant amount of uncertainty surrounding the content and timing of a replacement still exists, some Congressional leaders have reached out to states to explore options that would encourage innovative health care solutions at the state level.

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Challenges for Small Rural Practices in Value-based Care

December 14th, 2016

The Government Accountability Office (GAO) recently issued a report outlining five key areas in which smaller, rural physician practices tend to struggle as they shift from fee-for-service reimbursement to value-based care. Given the unique nature of rural medicine, and the fact that value-based payment will continue to grow, it is important to understand these challenges […]

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State Innovation Waivers, the Next Wave of Health Care Reform?

November 17th, 2016

One potential ACA replacement strategy could include punting health care reform to the states. The incoming administration could accomplish this is by significantly relaxing the 1332 innovation waiver requirements.

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Colossal Rate Increases; The Exception Or The New Rule

August 10th, 2016

Insurance premiums under the Affordable Care Act (ACA) are receiving increased attention due to reports of sharp 2017 increases by insurers. Across the nation, insurers have submitted initial premium increases and it is not uncommon for insurers to submit proposed rate increases in excess of 40-50% for 2017. State regulators will review the requests meticulously […]

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Incentivizing Young Adults to Buy Health Insurance

July 8th, 2016

In a recent announcement, CMS acknowledged the need to insure younger and healthier adults in order to contribute to a more balanced Marketplace risk pool and lower costs. CMS detailed a series of actions to step-up Marketplace outreach, especially to young adults who are still more likely than average to remain uninsured. While the suggested actions, […]

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