Insight, analysis & opinion from Joe Paduda
Medicare Set-Aside (MSA) vendor Health Advocates (HAI) has been sold to drug supplier Amerisource Bergen (ABC) for about four times projected 2006 revenues, or $83 million. Yes, that seems awfully pricey, but HAI is also quite profitable, with margins above 50%.
Based on an EBITDA multiple in the 5x – 6x range, the price doesn’t seem quite so outrageous.
Actiq, the lollypop pain killer, is rapidly becoming the biggest problem drug in workers comp. FDA approved only for treating cancer pain, the potent narcotic is now on most payers’ top 5 drug list (ranked by dollars spent).
There are likely several factors that have enabled a drug clearly not approved for musculo-skeletal conditions to achieve this high “honor”.
Kaiser Permanente, one of the oldest and largest HMOs, is going to offer PPOs, high deductible plans, and plans with Health Savings Accounts. This marks a significant change by the big HMO, one that at first seems odd.
But from a business perspective it makes a lot of sense, for two reasons
The PR and financial fallout from the recent reports of inappropriate retroactive denial of coverage is starting to take its toll on California’s Blue Cross plan. From Fierce Healthcare comes the latest news; the State of CA has levied a $200,000 fine against BX for their actions in one specific case.
And that’s just one case. Reports indicate there are as many as 19 more.
What does this mean for you?
If David is doing battle with Goliath and the venue is the court of public opinion, you’d best bet on the little guy.
OK, for the last and final time, Zurich and StPaul-Travelers are not merging, one is not acquiring the other, there are no due diligence conversations going on, books have not been exchanged, and whatever else I can say to convince the rumour hounds that this one has no basis in fact.
Could they merge at some point in the future? Perhaps. But there are no substantive discussions going on today, and there would be if the two companies were thinking about doing a deal.
How do I know? And do I know with 100% certainty? No to the latter, but 95% yes. As to sources, colleagues in both organizations have been denying this for months, and StPaul-Travelers went so far as to issue a denial. And a pretty firm one at that.
Sheesh. I wonder if Oliver Stone is behind all this nonsense…
The Blues have decided to get smart. Perhaps not smart, but at least smarter. Blue Cross of California’s much-publicized PR disaster arose when the LATimes published an article decrying the plan’s policy of trying creative ways to cancel policies for individuals who had the nerve to ask BX to pay for their medical problems.
Actually, the problem arose when the State of CA took legal action against BX.
If you have yet to shower, you may well need one after reading this.
Just in time for election season, another chapter in Ohio Bureau of Workers’ Comp scandal is heading for court. The latest news comes from the Toledo Blade, which reported last week that the BWC’s CFO is alleged to have accepted bribes from brokers for investment firms eager to invest the Bureau’s funds.
In yet another example of self-inflicted trauma, an insurer has been accused of illegally canceling health insurance policies for individuals with serious medical conditions.
We’ve made two changes to Managed Care Matters.
Least obvious to most will be the change in color of hypertext links; we are now using blue, which is more easily read by folks w certain types of color blindness. Thanks to friend Terry Reardon for the suggestion. (he’s a color blind orthopedic surgeon, who assures me that is not an occupational limitation…)
We’ve also added another step in the commenting process, asking submitters to enter a bit of text to verify they are a human and not a @#$%^&*&^%$^&**))*%%$## spam bot. Sorry for the extra step, but I can’t go thru 200 spams a day looking for your pearls.
One of the oft-cited rationales for Health Savings Accounts and Consumer Directed Health Plans (HSAs and CDHPs) is their potential to reduce the number of individuals without health insurance (or, as my neighbor says, the “individually self-insured). While HSAs may have some benefits in terms of increasing consumer awareness of costs, for two rather obvious reasons, HSAs will not help reduce the number of uninsured in the US.
