Why Building Customized Engagement Strategies for Integrated Payer-Provider Networks Is a Smart Long-Term Investment

Posted by Paul Darling on Wed, Jun 01, 2016

My colleagues and I recently have written about how pharmaceutical and medical products and services companies need to understand payers and provider systems in the context of their local healthcare markets when developing commercial strategies. An acute example of this dynamic are the integrated payer-provider networks (IPPNs), which comprise both a self-administered insurance plan and provider facilities. These networks have become increasingly popular across the United States, with healthcare provider organizations launching or acquiring insurance plans. 


>
Read More

Transitioning Pharma to Value-Based Payments Will Require More Than Corporate Collaboration

Posted by Paul Darling on Tue, Mar 01, 2016

Healthcare reimbursement in the U.S. is undergoing a fundamental transformation. The Center for Medicare & Medicaid Services has led this transformation, announcing that 50% of all Medicare payments will shift from fee-for-service to alternative payment models by 2018. Pharmaceuticals have been entirely omitted from these plans, as Medicare is legislatively prevented from negotiating drug prices. Hence, manufacturers and private payers are expected to play a dominant role in determining payment models that reimburse pharmaceutical manufactures for value in the form of patient outcomes, rather than the pills, themselves.


>
Read More

Adapting to the New Healthcare Ecosystem

Posted by Paul Darling on Wed, Feb 17, 2016

The evolution of U.S. healthcare gained pace and clarity as marked by some key events in 2015.  Specifically, more than 100 announced hospital mergers, three multibillion-dollar payer mergers, the successful defense of federal insurance subsidies in King v. Burwell, and the heated debate on drug prices point to an evolution with a clear direction that has important implications for life sciences companies.


>
Read More

A Tale of Two Cities: How Planned Hospital Consolidations in Atlanta and Chicago Epitomize U.S. Healthcare Ecosystems in Flux

Posted by Paul Darling on Wed, Jan 27, 2016

December’s news about planned hospital consolidations in Atlanta and Chicago is a reminder of how local healthcare ecosystems are changing in different ways and at different paces. In Atlanta, the year’s steady drumbeat of hospital consolidation news culminated in WellStar Health System’s announced acquisition of Tenet Healthcare’s five regional hospitals. At the same time, healthcare players in Chicago were reeling from the news that the FTC plans to block the merger of Advocate Health Care and NorthShore University HealthSystem, which would have formed one of the nation’s largest hospital systems.  


>
Read More

Will an Unlikely Dynamic Duo Take On Hepatitis C?

Posted by Paul Darling on Tue, Nov 17, 2015

As a number of healthcare partnerships, mostly in the form of accountable care organizations (ACOs), have recently formed, agreements between stakeholders outside of these ACOs are less common as many companies see the healthcare market as a zero-sum game. Contract negotiations between payers and providers over reimbursement levels or the exclusion of Gilead’s hepatitis C drugs by Express Scripts are more representative of the conflicts between stakeholders in the healthcare ecosystem.


>
Read More