Healthcare Finance Staff

So-called "pay for delay" deals between patent-holding pharmaceutical firms and would-be generics makers can now be challenged on antitrust grounds, although they are not necessarily anti-competitive, the U.S. Supreme Court has ruled.

The Medicare Payment Advisory Commission (MedPAC) has found that hospitals with a large portion of low-income patients also have higher readmission rates, and, therefore, higher penalties under Medicare's hospital readmissions reduction program.

Mid-Atlantic region payer CareFirst BlueCross BlueShield will launch in October an intelligent virtual assistant, called "Chloe," to help consumers who get their coverage directly from the payer's website to select the appropriate health plan.

There's a commonly held perception that healthcare is a process in which doctors take care of patients. But increasingly healthcare stakeholders are figuring out that, at times, a more effective way to help patients get healthy is to show them how to take care of themselves.

Payers wondering about competition under health reform might look to Denver, where underwriting regulations and a fair amount of provider concentration has left the commercial insurance market mostly divided into quarters.

  Last week, I received my weekly email update from the Maryland health insurance exchange: Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based exchanges.

Disruptive innovation challenges the status quo, drives change and creates new markets. But what does disruptive innovation mean in regard to health benefits and healthcare delivery?

Payers and employers are demonstrating that wellness programs can curb increases in healthcare costs and improve workforce productivity as employees become more involved in their health.

"Healthcare consumerism" is a phrase that has been bandied about for years by health insurance plans, but in practice it has often meant pushing more financial responsibility onto the patient, rather than reconstructing healthcare with the consumer's real interests at heart.

Healthcare experts have differing views on the benefits of consolidation to help reduce costs but agree that most healthcare organizations are moving forward with reform through innovation, and consolidation may be just a step in that direction, according to a session Thursday at the 2013 AHIP Institute on "Shared risk, shared opportunities: Cost containment strategies for an evolving marketplace."