Insight, analysis & opinion from Joe Paduda

Aug
7

Medicare sneezes

The adage goes something like – when the US sneezes, the world catches a cold, signifying just how much influence this country has on the rest of the world.
That’s analogous to Medicare’s impact on the health care sector. And Medicare is about to change the way it pays hospitals, a change that will have a dramatic effect on every private payer from HMO to individual carrier to workers comp insurer to self-insured employer.

Continue reading Medicare sneezes


Aug
6

CMS denies off-label Actiq coverage

The latest shot in the battle against drug costs comes from the Centers for Medicaid and Medicare Services, which is reported to be denying coverage for off-label use of drugs such as Actiq and Fentora.
Whenever CMS moves, the healthcare world shakes, and this is no exception. There are a host of possible ‘downstream implications’ in areas as diverse as workers comp, formulary management, and hospice.

Continue reading CMS denies off-label Actiq coverage


Aug
2

Coventry and health plan profits

Coventry’s latest quarter was a good one. The key to financial success in the health plan business is the MLR, or medical loss ratio; Coventry delivered a Q2 MLR of 77.5% resulting from a combination of higher premiums and lower than expected medical claims. Premiums were up 5.1% YTD, while the medical expense increase was slightly lower at 4.9%.

Continue reading Coventry and health plan profits


Aug
1

Murdoch is out! WSJ taken over by Chicken Little!

To listen to some, you would think single payer health care will cause the sky will fall, and it will be full of really large rocks when it hits our heads.
At least that’s what the editors at the Wall Street Journal (subscription required) would have you believe will happen if Wisconsin adopts a single payer system.
While I’m no fan of single payer, I’m even less enamored of junk economics masquerading as policy analysis. And junk is what the editors’ arguments are.

Continue reading Murdoch is out! WSJ taken over by Chicken Little!


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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