Today's Datapoint

$4.7 million ... was saved in the first six months of 2013 under a commercial accountable care organization formed by Anthem Blue Cross and HealthCare Partners in California.

Quote of the Day

“Everyone’s got a different definition of ‘specialty’; there is no one definition of what a specialty medication is. Ours [at Prime Therapeutics LLC] is a very narrow list; it comprises about 0.4% of claims [while other PBMs have specialty drug lists that may be closer to 1% of claims]. We try to be very specific in saying, ‘Nope, a specialty drug has to require specialty handling, it has to run through a specialty pharmacy to educate members on that specialty handling, [and] it truly has to be managed differently than a traditional medication.’”



— Peter Wickersham, senior vice president, integrated care and specialty at Prime Therapeutics LLC, told AIS’s Drug Benefit News.

Annual Growth in Medicaid Enrollment, By Enrolled Population, 2007-2012

	Aged & Disabled	Families	Total
2007-08	2.7%	3.3%	3.1%
2008-09	3.5%	9.5%	7.8%
2009-10	3.6%	8.5%	7.2%
2010-11	4.0%	5.0%	4.7%
2011-12	3.1%	2.3%	2.5%

 
Source: Kaiser Family Foundation

A recent report by PwC's Health Research Institute projects a net healthcare spending growth rate...

... of 4.8% in 2015, after accounting for likely changes in benefit design such as higher deductibles and narrow networks.

Source: "PwC’s Health Research Institute Projects Modest Uptick in Healthcare Spending Growth Rate in 2015," Pricewaterhouse Coopers Press Release, June 24, 2014, http://www.pwc.com/us/en/press-releases/2014/pwcs-health-research-institute-projects-modest-uptick.jhtm

Today's Datapoint

Just 9 of the nation’s 23 federally backed CO-OPs have hit their enrollment projections, while 14 brought on far fewer members than projected, according to a House Oversight and Government Reform Committee probe.

Quote of the Day

“Palliative care could be in place for years after a diagnosis. Too often, patients and their families are never asked by their physician or caregivers how they would like to be treated. And not every patient wants curative therapy. Palliative care, if done right, begins by asking patients what matters to them and their families. Sometimes palliative care is needed to alleviate the effects of curative care.”


Mark Ganz, President and CEO of Cambia Health Solutions — which recently included palliative care coverage in commercial health insurance products it sells — told The AIS Report on Blue Cross and Blue Shield Plans*.

According to a recent survey:

• 85% of the employers surveyed have implemented or are considering an increase in employee cost sharing
• 18% of employers surveyed now offer a high-deductible plan as the only insurance option for employees
• The in-network deductible is $1,000 or more for 40%of employers, up from 16% in 2010
• 71% of employers offer wellness programs

Source: "PwC’s Health Research Institute Projects Modest Uptick in Healthcare Spending Growth Rate in 2015," Price Waterhouse Coopers Press Release, June 24, 2014, http://www.pwc.com/us/en/press-releases/2014/pwcs-health-research-institute-projects-modest-uptick.jhtml