Health insurance payers’ original function as financiers of care has evolved over the decades. In the current healthcare environment, payer roles range from risk manager to health navigator to provider of care. Across these roles, the importance of their subscribers’ health outcomes remains at the forefront.
With spiraling cost inflation and outcomes that lag many other developed economies, the US government’s healthcare insurance authority (CMS), is driving reform aimed at better quality and lower cost, and private payers are following suit. Both state and private payers are moving toward alternative payment models, like value-based payments, that…
In a recent move that garnered considerable attention, Express Scripts, one of the largest pharmacy benefit managers (PBMs) in the US, announced a plan that would link the price of some cancer drugs to their real-world performance.1 Although this isn’t the first time that an alternative pricing model for drugs has…
With the recent explosion of healthcare data in the U.S. as well as the announcement of several well-publicized partnerships between manufacturers and providers or payers, the emergence of data collaborations is currently one of the hottest trends in healthcare. It’s no secret that the pharmaceutical industry is facing a series…
There is a looming population group poised to impact the US healthcare system with a voracious appetite for healthcare. The group has been dubbed the ‘silver tsunami’– a name that our research shows first appeared in a 2002 paper by University of Nevada, Reno professor Mary Finn Maples. So how…
While the pharmaceutical and medical device industries have found themselves in a turbulent healthcare marketplace rife with changing regulations, new competitive challenges, and increasing pricing pressures, the end goal for manufacturers remains the same — product reimbursement and optimal pricing. These two terms are regularly linked together because reimbursement is…
