In the last two decades, national health expenditures have more than doubled from $1.5 trillion in 2001 to $4.1 trillion in 2020, accounting for 14.0% and 19.7% of the US Gross Domestic Product (GDP), respectively. One may wonder, How far...
Read moreThe Most Promising Value-Based Model in the Commercial Market: the Lean Value Model
Nearly 160 million individuals are covered by employer-sponsored health insurance, accounting for about 50% of the U.S. population. However, the cost of such coverage has increased by 20% in the last five years and 43% in the last decade. As of...
Read moreAmazon Care vs. One Medical: a Tale of Two Primary Care Innovation Models
On July 21, 2022, Amazon announced its $3.9 billion bid for One Medical, a primary care innovator. Some industry observers consider this a smart move by Amazon, while others think this might be another failed attempt. The deal is...
Read moreDigital Mental Health Has an Achilles’ Heel in Generating Savings for Payers. But There is a Way Out.
Digital mental health is a sizzling-hot area that attracts a large amount of investment. In 2021, venture capital poured $5 billion into digital mental health startups, accounting for one-sixth of the $30 billion investment in digital health. In...
Read moreWhy Did New York City’s $30-Million Mental Health Program Fail?
In July 2015, the first lady of New York City – Chirlane McGray – announced a 5-year Connections-to-Care (C2C) program that aimed to transform mental health service delivery to low-income populations. It had a budget of $30 million...
Read moreGreat Disappointment: Some Policymakers Ignore Basic Economics in Drafting Prescription Drug Pricing Policies
Last week, the U.S. Senate leaders started efforts in reviving the Build Back Better bill, including Medicare prescription drug price regulations. The main provision is to allow Medicare to negotiate drug prices directly with manufacturers for up...
Read moreRegulating Pharmacy Benefit Managers’ Rebate Practices: Are We Barking Up the Wrong Tree?
On June 7, the Federal Trade Commission (FTC) launched “an inquiry into the prescription drug middleman industry,” seeking documentation and records of business practices from the six largest pharmacy benefit managers (PBM). The goal is to...
Read moreInvesting in a RosenCare-Like Model Could Generate Savings for Employers
This is a follow-up article to “A Tale of Two Employer-Based Healthcare Models” in which we compare and contrast RosenCare and Haven Healthcare. In the last three decades, RosenCare has been able to offer quality care and spend 30 to 50% less on...
Read moreA Tale of Two Employer-Based Healthcare Models: RosenCare vs. Haven
Back in 2016, I became aware of RosenCare at a conference held in Orlando, Florida that focused on employer-sponsored on-site or near-site clinics. Rosen Hotels & Resorts gave a presentation about its healthcare delivery model, and I was very...
Read moreTaming Healthcare Cost: Massachusetts is Caught Between a Rock and a Hard Place
Early this month, the Massachusetts Department of Public Health approved a $2-billion expansion plan submitted by Mass General Brigham (MGB, formerly Partners HealthCare), the largest provider system in the state. This approval is part of...
Read moreInnovative Kidney Care Models Generate Tremendous Savings
Chronic kidney disease (CKD) imposes a large burden on patients and families and the US healthcare system as well. Approximately one out of seven US adults has CKD. In 2019, Medicare fee-for-service beneficiaries with CKD had an all-cause...
Read moreMedicaid’s 12-Month Continuous Eligibility Reduces Churning
Frequent moving in and out of Medicaid due to income fluctuation, known as churning, has been demonstrated to increase insurance coverage gaps, disrupt access to health care, increase unnecessary administrative burden, and lead to...
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