Healthcare

Healthcare is a fascinating topic that is oftentimes literally life and death. I covered healthcare for HealthLeaders Media for three years. I wrote a weekly health insurance column, as well as created and oversaw a news desk of editors. I now write about the topic for Healthcare Dive. Here are some of the articles I’ve written on the topic.

Providers Go Deeper with Population Health, Weighing Social Factors

The industry transition to value-based payments is leading to more population health management programs, but providers are finding it’s difficult when patients lack secure housing, access to food or a way to get to appointments. So many are now going beyond one buzz word, population health, and taking into account the role that another, social determinants of health, play in a person’s health.

5 Payer Trends to Watch in 2018

Looking ahead to next year, you can expect payers to implement more cost-saving measures and push for value-based contracting. Here’s a look at five payer trends to watch for in 2018, and some tips for preparing to deal with them.

Why Payers are Flocking to the Medicare Advantage Market

Medicare Advantage (MA) and the Affordable Care Act (ACA) exchanges are both federal programs, but they couldn’t be more different in payers’ eyes. Insurance companies are entering or expanding their footprints in the MA market, while simultaneously pulling back or out of the ACA exchanges. They’ve found success in MA. Not so much in the ACA exchanges. Here’s why.

How Will Instability in the ACA Exchanges Affect Healthcare in 2018?

Threats, actions and inactions from Washington, D.C., have left the Affordable Care Act (ACA) exchanges teetering and insurance companies fleeing the individual market for 2018. What will this mean for payers and providers in 2018?

How Will Expanding Catastrophic Health Plans Affect Providers?

President Donald Trump’s recent executive order to expand catastrophic health insurance plans would offer a low-cost alternative to people in the Affordable Care Act (ACA) exchanges. However, there are serious questions about what they would mean for consumers, providers and hospitals.

Trump Eyes Executive Order to Cripple Individual Mandate

President Donald Trump’s administration has reportedly prepared an executive order to end the Affordable Care Act’s individual mandate. Trump may direct his departments to not enforce the mandate and could allow for more hardship exemptions that let people avoid fines for not having coverage.

What Will be the Fallout from Anthem’s New Imaging Policy?

A movement health systems have been dreading is gaining speed, as commercial and government payers are implementing more and more policies that restrict reimbursements for services that can be performed outside a hospital. Anthem’s recent announcement that it will no longer pay for MRIs and CT scans performed at a hospital in an outpatient basis could be a harbinger of what’s to come.

CareSource Will Cover Final County Without an ACA Option in 2018

Healthcare and state officials once fretted about dozens of potential bare counties in 2018 and the potential for thousands not having any Affordable Care Act plan options. However, state insurance department officials and insurers worked together to fill in the holes, including the final open county in Ohio.

Health Reform Driving Payer-Provider Partnerships

Payers and providers have for decades stayed in their silos, leading to a more fractured and adversarial healthcare system. That relationship, however, is starting to soften for many in the industry. Payer-provider partnerships put the two groups on the same team in hopes of reducing costs and improving care and outcomes through sharing data and better communication.

Alzheimer’s Patients Need Special Care, But Providers Aren’t Ready to Give It

Diagnoses of Alzheimer’s disease have been increasing and are expected to skyrocket, but the health system has been slow to respond. Here’s a look at hospitals are responding to the crisis.

DOJ Sends Warning Shots on Medicare Advantage Overpayments

The Medicare Advantage program seems to be hitting the sweet spot, but its popularity and more money going to the program has brought more scrutiny. The Department of Justice is investigating Medicare Advantage payers and involved in multiple court cases.

Children’s Hospitals — And Their Patients — Caught in the Crosshairs with Planned Federal Cuts

More cuts to Medicaid and CHIP would reverse the trend of fewer uninsured Americans, including children. Here’s why children’s hospitals may feel the pain.

Uneasy Payers Seek More Guidance as ACA Exchange Deadline Nears

The Washington, D.C., drama of will they/won’t they in terms of whether Republicans will pay cost-sharing reduction payments to insurers in the ACA exchanges is making payers nervous. Here’s what is going on in the industry.

Nurse Burnout: 3 Low-Cost Ways Hospitals Can Help

Nurses are feeling stressed, burnout, and are leaving the profession. Here is what’s causing the problem and what hospitals can do about it.

How Hospitals Can Prepare for an Influenza Pandemic

Public health officials agree that the next major pandemic will be influenza. Are U.S. hospitals ready for it? I wrote this piece for Healthcare Dive about the issue.

5 Changes Health Plans Need to Make Now

It’s fascinating to look back at your writing to see if your predictions were right. Here is a column I wrote for HealthLeaders Media that talked about what changes were needed at the time. Check out what I predicted in this 2010 column.

Health Savings Accounts Likely to Change

More people have health savings accounts (HSAs) connected to high-deductible health plans (HDHPs) than ever before — and that number could skyrocket in coming years, as the Republican-controlled Congress and White House look to make changes to healthcare. This article talks about HSAs, their growing popularity, and what to expect in the coming years.

Healthcare Consumerism – Will It Catch On?

Healthcare consumerism is seen as a way to reduce costs and make better healthcare consumers. The idea trumpets giving people more information about cost and quality so they can make better healthcare decisions. However, skeptics view healthcare consumerism as just a way to pass more healthcare costs onto individuals. This article takes a look at healthcare consumerism and how a Republican-controlled White House could put emphasis on the idea.

What’s the Difference Between PPO, HMO, HDHP, POS, EPO?

Many Americans struggle with health insurance literacy. The industry is confusing and in many cases, people put off health decisions because they’re confused by the whole process. In this guide, I wrote about five of the most popular health insurance plans to help people make the right decision for your circumstances.

3 Steps to Lower Insurer Overhead Costs

Keeping overhead costs under control is a key part of controlling health insurance costs. Here is a column I wrote when this was a hot topic in the days after Obamacare’s approval. I specifically wrote this for health insurance leaders about how they can lower overhead cost, so it’s very “inside baseball.”

4 Ways Health Reform Could Spark Wellness Programs

Healthcare reform brought a flurry of articles and columns about how Obamacare would change healthcare. Here’s my take on how health reform could spark wellness programs.

Insurers Must Push Employers to Reward Value

Value-based insurance design is a theory of creating health plans that are focused on value and quality and look to reduce overutilization of services and medications that are not top value. This column looks at the move of adding value to health insurance plans.

Economic Climate Changes Banks’ Relationships With Hospitals

The financial crisis affects banks’ relationships with hospitals. This article takes a look at the money problems and offers creative solutions for hospitals to get access to capital.

Brown’s Senate Win Creates Health Reform Dilemma for Democrats

Scott Brown’s win in Massachusetts during the healthcare reform debate sent shockwaves throughout politics and healthcare. Here is a column I wrote at the time about the situation and Massachusetts health leaders’ reaction.

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