Insight, analysis & opinion from Joe Paduda

Nov
8

What now?

The Democrats’ capture of the House will bring new focus to health care, the uninsured, prescription drug pricing, and Medicare Advantage programs. Here’s the prognostications.

Continue reading What now?


Nov
7

the flattening world of health care

Medical tourism looks to be exploding, growing much faster than many (your author included) had expected. The latest figures indicate a half-million Americans sought care overseas last year.
Much of the care is delivered in Canada and Mexico, but lots of folks are traveling to India and Thailand for complex medical procedures. And the quality appears to be quite high in many of the facilities.

Continue reading the flattening world of health care


Nov
6

Coventry’s WC acquisition strategy

Coventry’s public statements and documents point to a possibility that the big managed care company will be looking to expand it’s workers comp offerings through acquiistion. The business, known to the cognoscenti as First Health Workers Comp, has made little progress since it was acquired by Coventry almost two years ago. FH is suffering from a lack of attention by Coventry senior management, flat revenues, and serious competition from Aetna and others.
While acquiring more WC entities may help FH, basic logic would indicate that before you add to a company, you ought to make sure the company you have is running smoothly.
Otherwise all you’re doing is putting lipstick on a pig.


Nov
6

Drugs, profits and politics

By any accounting, Part D has been a boon to the pharmaceutical industry (free registration required). Revenues and profits at Pfizer, Lilly, and other manufacturers have jumped. This will undoubtedly lead to more research dollars available to search for cures for awful diseases, an effort exclusively funded by the US taxpayer that will benefit the entire world.
Aren’t we generous?

Continue reading Drugs, profits and politics


Nov
3

Medicare games

The annual Medicare physician price cut season is on us. Next year’s reduction will average 5%, although payments for office visits (evaluation and management codes) will increase by up to 30%, but reimbursement for other procedures will be slashed up to 20%.
Don’t expect this to actually happen; every year the Medicare reductions are reversed by Congress. And this year will be no different. I’d expect Congress will do something to reverse the cuts, at least in part.

Continue reading Medicare games


Nov
2

The CVS – Caremark deal – why?

Retail pharmacy chain CVS is buying pharmacy benefit manager Caremark in a deal that will create a really big vertically integrated drug company.
Here’s what is behind the deal.
CVS wants more control over its customer base, and with more and more consumers buying their drugs through PBMs, they get more control by creating the industry’s biggest PBM. As I’ve noted before, the market power of PBMs will only increase as Part D becomes the primary force driving retail drug purchasing behavior.
CVS decided that rather than be at the end of the supply chain, it had to move up if it was to control its destiny.

Continue reading The CVS – Caremark deal – why?


Nov
1

UHC’s Bay area battles

United HealthCare’s bare-knuckle approach to contracting may cost it members. Employers in the San Francisco bay area are deciding to go with other health plans as UHC experiences ongoing difficulties in recruiting and retaining docs.
One of UHC’s competitors is aggressively pursuing UHC customers by offering to sign them up at the same rates UHC was charging.

Continue reading UHC’s Bay area battles


Oct
30

Wal-Mart’s $4 drugs – much ado about not much

The world (at least the very small part of it that I inhabit) has been buzzing about Wal-Mart’s announcement that it will be pricing almost 300 generic drugs at $4 for a 30 day supply. Newspapers, private equity firms, PBMs, drug manufacturers, insurers, policy makers, and politicians are all rambling on about the various significant impacts this will have on the world, among them improving the lives of the uninsured.
I don’t get it.

Continue reading Wal-Mart’s $4 drugs – much ado about not much


Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL

SEARCH THIS SITE

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.

 

DISCLAIMER

© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives