Topic: Policy & Health Reform

Azar Testified on Drug Pricing. Industry Yawns.

John Gorman

Health and Human Services (HHS) Secretary Alex Azar  was in front of the US Senate Health Committee for a hearing today on drug pricing. His prepared remarks freaked out the market open saying the US “fundamentally may need to move toward a system without drug rebates, where PBMs and drug companies just negotiate fixed-price contracts.”

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CMS’ Venture Into the Direct Contracting Model

David Sayen

In business school, they taught me that humans are naturally risk averse. Makes sense from an evolutionary perspective. What about physicians? After all, their code is to “do no harm.” If not harming the patient ranks higher than helping the patient, that tells me risk aversion thrives with physicians as opposed to, say, real estate developers and entrepreneurs. What does this tell us about unfolding events in our healthcare bubble?

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Group Retiree Medicare Advantage Products Are Poised to Explode in 2019

John Gorman
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President Trump unveils a Blueprint to Lower Drug Prices

Jean LeMasurier

On May 11, 2018, President Trump unveiled his Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs entitled “American Patients First”. The President emphasized lowering drug prices as one of his greatest priorities during the campaign and promised to use the federal government’s purchasing power to negotiate lower drug prices to protect consumers, in particular Medicare beneficiaries, from being ripped off by greedy drug companies.

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Could Medicare Advantage Be Facing More Legislative Reform This Year?

Olga Walther

The House Ways & Means Committee held a hearing Tuesday on the Medicare Advantage (MA) program. Lawmakers eagerly pointed out the success and bipartisan support for the program and were generally very receptive of the feedback received from the panel of experts. The panel included two plans – Clover Health and Independence Blue Cross of Philadelphia – and two policy researchers.

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The Open Enrollment Period Changes Everything

Betsy Seals

Within the Final Rule, the Centers for Medicare & Medicaid Services (CMS) confirmed the reinstatement of the Open Enrollment Period (OEP), which allows a one-time enrollment election from January 1 – March 31 beginning in 2019. For those of us who have been in Medicare Advantage (MA) for a while, we may have had a few déjá vu moments with this announcement (or was that just me?). When we start really thinking about the reinstatement of the OEP, we may be tempted to dust off those old OEP strategies. However, from our perspective, reemploying old strategies would be a mistake. For new plans, or those new to MA, who have never been through an OEP, there is even more to consider from a strategic perspective. While we wait for the Final Medicare Marketing and Communication Guidelines, as well as the Enrollment Guidance, which will tell us where the OEP will fall in the hierarchy of enrollment periods – here are some things to start thinking about:

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Takeaways from the Gorman Health Group 2018 Client Forum

John Gorman

The Gorman Health Group 2018 Client Forum concluded last week in Las Vegas with over 300 of our closest clients and partners. As we enter our 22nd (!) year, we returned to the Red Rock Resort where a great time and shared learnings were had by all.

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