The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.
Pharmaceutical companies want to be rewarded for innovation, but rising drug costs are straining payor economics. This conundrum must be solved, not for one drug at a time but across the breadth of products in the pipeline.
In our healthcare system, those in the best position to control risks and costs often have inadequate incentive to do so. Refining healthcare financing and reimbursement requires a deep understanding of the nature of medical risk.
Employers are showing increasing interest in new payment, delivery, and funding models. To capture the opportunity, payors must be able to target appropriate employers; educate employers, employees, and brokers; and demonstrate savings.
Four fundamental questions can help payors and providers improve productivity and better control utilization—the prerequisites for making value-based care sustainable.