March 2016

It’s survival of the biggest because of IT, data collection, and other factors. But the health insurance market is also full of nooks, crannies, and niches that are friendly to small fry and newcomers.

Jan Greene

The trade association has been hit by defections, deficits, and staff departures. Can Marilyn Tavenner, AHIP’s new CEO, get it back on course?

Richard Mark Kirkner

CMS veteran Marilyn Tavenner oversaw a rocky debut for HealthCare.gov. Now she’s at the helm of AHIP as some major members need to be coaxed back into the fold.

Interview by Richard Mark Kirkner

A desire for more control and the ACA seem to be fueling the long-term trend.

Peter Wehrwein

Coverage kicks in if someone has a major illness like a heart attack or stroke. And because critical illness policies are a voluntary benefit, they help employers cut costs to avoid the Cadillac tax on health benefits.

Joseph Burns



Departments
Legislation & Regulation

Free-market advocates question state say-so over major hospital projects. They have a strange bedfellow.

Richard Mark Kirkner
ACO Update

ACOs are providers while MA plans are insurers. Still, CMS’s Next Generation ACOs have a familiar look and feel.

Robert Calandra
Viewpoint
The hope is that reducing the per capita cost of health care by combining these stakeholder roles should remove volume as an incentive and excess charges as a temptation.
Richard Stefanacci, DO
Plan Watch

UnitedHealthcare, Aetna, and Humana all lose money, but Cigna’s CFO says that’s just the price for getting started in a new market.

Frank Diamond
Cancer Watch

Cancer patients talking to doctors doesn’t work very well: Half of all symptoms go unreported. Computerized systems and email prompts may do a better job.

Peter Wehrwein
Tomorrow’s Medicine

Alirocumab, evolocumab, and sebelipase alfa further fuel the discussion about just how to go about covering exciting, but costly, high-priced agents.

Thomas Morrow, MD
Snapshot

Percent of U.S. health care spending by 7 core health consumer segments