Looking out at the San Francisco skyline from the top floor of the Westin St. Francis on Day 3 of the 42nd Annual J.P. Morgan Healthcare Conference, the iconic Transamerica pyramid is not too far away. But my mind, being...more
Sustainability of our healthcare system was an interesting topic at Day 2 of the 42nd Annual J.P. Morgan Healthcare Conference. Paul Markovich, CEO of Blue Shield of California, expressed the concern that “[T]he status quo is...more
Here’s a new word I heard today that I will awkwardly insert into my next conversation – “transrupt.” It is what happens when you have simultaneous disruption and transformation that both damages the existing system and...more
What do Centene, CVS Health-Aetna and Humana all have in common? (Trying really hard not to start off with a “three health plans walk into a bar” joke…). Well, if you were at the 41st annual J.P. Morgan Healthcare Conference,...more
I was struck on the first day of the 41st Annual J.P. Morgan Healthcare Conference by Sanjay Doddamani (CEO of UpStream Healthcare) saying that “Health is a state of independence.” A simple statement, but a very profound and...more
1/10/2023
/ ACOs ,
EBITDA ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Patients ,
Pharmaceutical Industry ,
Popular ,
Value-Based Care
For those of you who know me, I like to have fun with my Zoom backgrounds – choosing photos of interesting scenery or changing them mid-call to reflect my mood or negotiating strategy. Sitting in front of my computer this...more
1/12/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Investigation Demand ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
EBITDA ,
False Claims Act (FCA) ,
Healthcare ,
Humana ,
Medicaid ,
Medical Loss Ratio ,
Medicare Advantage ,
Moderna Inc. ,
Pfizer ,
Vaccinations ,
Value-Based Care
It’s Day 2 of the J.P. Morgan Annual Healthcare Conference at its finest – looking closely at healthcare inequities, strategic business shifts and killer robots, all in the same day! (Yes, we did say killer robots and it’s...more
1/13/2021
/ Anti-Discrimination Policies ,
Coronavirus/COVID-19 ,
Diversity ,
Equity ,
Financial Institutions ,
Financial Stimulus ,
Healthcare ,
JPMorgan Chase ,
Medicare ,
Medicare Advantage ,
Social Justice Issues ,
Telehealth
Sitting in the dark before 6 am in my Los Angeles house with my face lit up by yet another Zoom screen, wearing a stylish combination of sweatpants, dress shirt and last year’s JPM conference badge dangling around my neck for...more
1/12/2021
/ Affordable Care Act ,
CMMI ,
Coronavirus/COVID-19 ,
Electronic Protected Health Information (ePHI) ,
Healthcare ,
Home Health Care ,
Humana ,
Insurance Industry ,
JPMorgan Chase ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Mental Health ,
Moderna Inc. ,
Over The Counter Drugs (OTC) ,
Pfizer ,
Professional Conferences ,
Public Health Emergency ,
Teleconferences ,
Vaccinations ,
Value-Based Care ,
Walgreens
CMI, CMMI, and Changing the Consumer Experience in the U.S. and China -
Case Mix Index: Sitting in multiple hospital, payor and physician organization presentations at the J.P. Morgan healthcare conference this year, it is...more
1/17/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
China ,
CMMI ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
Hospitals ,
Life Sciences ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Outpatient Services ,
Universities ,
Value-Based Care
Laguna Niguel, California. Another wild year in healthcare is upon us and another insightful and inspiring week of discussions at the 2019 Health Evolution Summit (HES) has just wrapped up in California. HES, which many refer...more
WHO IS AT RISK -
The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo...more
In a court decision last year in Swoben v. United Healthcare, the United States Court of Appeals for the Ninth Circuit held that an allegation – that a Medicare Advantage Plan performed a “biased” HCC-RAF retrospective...more
Day 3 of the JPMorgan healthcare conference was one of striking contrasts between the old and the new. (And, by the way, the rain finally stopped for a day, but it will be back tomorrow to finish off the last day of the...more
A large amount of wind, much discussion about the U.S healthcare, and the public getting soaked again – if you were thinking about Washington, DC and the new Congress, you’re 3,000 miles away from the action. This is the week...more
1/11/2017
/ Affordable Care Act ,
Ambulatory Surgery Centers ,
Employee Benefits ,
Employer Group Health Plans ,
Health Care Providers ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Mental Health ,
Patients ,
Professional Conferences ,
Repeal ,
Telehealth
A new study by Stanford University researchers finds that Medicare Advantage plans pay lower prices than traditional fee-for-service (FFS) Medicare for most types of hospital admissions. According to the study—published...more