All Articles In 'Competition'
Physician Payment Reform: Preparing for Value-Based Reimbursement
Primary care is shifting to payment based on providing higher quality, lower cost health care. New payment models – such as patient-centered medical homes (PCMH) – replace or supplement traditional fee-for-service payments with per-member per-month payments, [...]
Health Insurance Exchange Implementation: Timeline and CMS Progress Report
In recent testimony to the Senate Finance Committee, Gary Cohen of the Centers for Medicare and Medicaid Services (CMS) gave an update of progress on Health Insurance Exchanges (HIX) implementation, now called Health Insurance Marketplaces. There [...]
5 Causes of Wasteful Health Care Spending
A painful fact about the U.S. health system is that roughly one third of health costs and spending are wasted. A study in the Journal of the American Medical Association (JAMA) found that wasted health spending [...]
Patenting Human DNA: SCOTUS Pharma and Biotech Case Preview
Patents form the basis of the pharma and biotech industry, also called the life sciences industry. They give companies an incentive to make large investments in risky drug development and innovations, which have the potential to be ineffective or to [...]
Obamacare and State Laws: States Slow to Enact ACA Consumer Protections
State insurance commissioners typically bear most of the responsibility for enforcing health insurance consumer protections. In theory, that will remain the case after broad new consumer protections included in the Affordable Care Act (ACA) go into [...]
State Tort Liability for Generic Prescription Drugs: SCOTUS Pharma and Biotech Case Previews
Generic drugs have operated under a different set of rules than brand-name drugs since 1984, when Congress passed the Drug Price Competition and Patent Term Restoration Act of 1984, or Hatch-Waxman Act. Brand-name drug manufacturers must [...]
Legality of Pay for Delay Settlements: SCOTUS Pharma and Biotech Case Preview
The 2012 Supreme Court got a lot of attention for its decision to uphold most of the Affordable Care Act (ACA) health reform law in NFIB v. Sebelius. But this year’s court docket will be no [...]
Essential Health Benefits: Most State Benchmark Plan Options Cover Similar Services
Essential health benefits (EHB) will play a fundamental role in shaping health plans after 2014. Part of the Affordable Care Act (ACA), EHBs define a baseline of 10 types of services those plans must cover, including [...]
Price Transparency in Health Care: Guidelines for Healthcare Purchasers from Catalyst for Payment Reform
Opaque prices – the norm in U.S. health care – in a key driver of inefficient, ineffective medical care and rapid cost increases. Transparency of health care prices – public reporting of prices – is an [...]
Medicare Advantage Payments: ACA Policies Would Have Saved Billions if Implemented in 2009
Medicare Advantage plans provide many benefits to Medicare beneficiaries, including lower costs, added services, higher quality than traditional fee-for-service (FFS), and less paperwork. However, the way Medicare paid Medicare Advantage health plans led to a situation where [...]
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