Insight, analysis & opinion from Joe Paduda

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Friday catch-up

Here in the East summer is still in full force, no matter what the calendar says – but the work load has ramped up now that school is back in session and 2016 planning is well under way.

Two items of note that came across my virtual desk this week…

The latest data indicates premium increases for the benchmark silver plan in 13 key markets average 3.1% for those without subsidies, 1.0% for subsidized plans.  Premiums decreased in 4 markets and increased in 9.

Access to care post-reform implementation doesn’t seem to be too problematic – at least not according to primary care providers.  80 percent said their ability “to deliver high-quality care” had stayed the same or improved; 20% said it had worsened.

The connection between diet and health is clear and strong, as is the relatively poorer health status of poorer people.  A compelling piece discusses why the less-affluent have lousy diets – and it isn’t because they like Big Gulps and Cheetos.  Here’s a key excerpt:

…participants are, by virtue of their qualifications, extremely pressed for cash. They eat fewer meals as a result, and select for more caloric foods, which tend to be less healthy, in order to adjust. Starch-heavy meals, fattier fare, and sugary foods all tend to be cheaper.

Part of it, however, might also be driven by the absence of free time to cook foods which require longer prep times (often vegetables). Convenience, in other words, can be a diet killer.

Before you criticize SNAP and belittle recipients, read the article.

California will have a drug formulary within 18 months.  Expect this trend to expand pretty quickly. There are at least a half-dozen states seriously considering formularies with several others beginning to explore the concept and implementation thereof.  One is North Carolina; I’ll be speaking at the NC Industrial Commission’s annual conference next month on the topic.

One observation – expect formularies and the rules and regulations that support enforcement thereof to evolve quickly from the Y/N model to a much more sophisticated form.

Got to get back to it – September is a very busy month!

Joe Paduda is the principal of Health Strategy Associates



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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