…a “network” has ceased to be a neutral mechanism for organizing care. It has become an instrument of control — one that dictates who patients can see, how physicians can practice, and how fiduciaries must spend plan assets they are legally bound to protect.
The Holy “Network”: Why It’s Time to Retire Healthcare’s Most Dangerous Word
— Chris Deacon (more…)
What a great movie and inspiring story! Of course, if you’ve seen the movie, you know that much of the story is really about the contrast and tension between the team of Carroll Shelby/Ken Miles and the venerable industry giant, Ford Motor Company. Ford had the industry might, but it couldn’t leverage its resources sufficiently to beat Enzo Ferrari and his team. (more…)
QUESTION: How can we afford life-saving drugs?
ANSWER: Spend less on non-life-saving drugs!
Now that wasn’t so hard. (more…)
Diabetes is generally the most expensive and fastest growing therapeutic class within the majority of corporate drug benefit plans. It presents a huge population health problem and affordability challenge. Yet, we are wasting ever more billions of dollars overtreating Americans with respect to diabetes and obesity. (more…)
As another year passes, it makes me think about planning for retirement. No, this isn’t a retirement announcement. I’m just doing some end-of-year self-reflection — an annual status check so to speak. And, for a change of pace, this year I am sharing my thoughts with whoever reads this. (more…)
Among other things, the Consolidated Appropriations Act (CAA) requires group health plans to attest that they are in compliance with the CAA’s gag clause prohibition. TPAs and PBMs seem ready to attest (or sub-attest).
But what’s an employer to do if its plan is not in compliance? And what if the TPA or PBM doesn’t contractually restrict the data, but in practice restricts the data? Is it okay for a TPA or PBM to restrict information as long as they don’t contractually do so? This sure seems contrary to the intent of the law! (more…)