GLG News by Managed Care Experts

Primary insurers and reinsurers will demand that catastrophic modeling be used in order to justify their underwriting decisions of this type of insurance.  These newer models in conjunction with in-house capacity aggregation tools (Insurers now know where and how much of their capacity...

Increasing interest rates and debt service, a Decrease in available cash, a Migration to more fixed rate borrowing and appeals to state governments for assistance, a delay in physical plant additions/upgrades

Pennsylvania is a bell weather for hospital reporting in the US.  The "hospital costing containment council" (I forget the name) is famous for highlighting percentage of patients acquiring hospital infections after arrival.  Accountability for these very high costs lay with people managing...

I believe insurers and pharmacy benefit management companies will coverage of Vytorin.  Most likely, it will lose any preferred status, (formulary Tier 2), and move to non-preferred brand, (formulary Tier 3 or Tier 4), depending on the drug reimbursement system in the health plan.  As an example,...

If I may, Mr. Goldstein suggests that education to providers re: cost/benefit or value will drive drug selection.  I disagree in that there are may barriers to provider (most physicians) behavior and their selection of drugs.  To mention a few are as follows:  1. My anecdotal experience...

From the rather strick interpretration of Peter Stark's antitrust principles complied with mostly in the 1980's we have entered an era where rampent greed and highly sophisticated antitrust relationships exists in nearly of all hospitals especially with their own "dedicated" (read as owned)  multispecialty...

Illegal and unethical bribes to orthopedists have gone on since time immemorial and have been visible throughout the medical and device profession and business.  Yet little (despite Peter Robert Stark's attempt) to separate this added incentive from the most highly paid specialists in medicine,...

The DOJ joins in when they have reviewed materials and believe it likely that there is a case with some civil or criminal violations.

For one reason, this industry has outperformed the commercial average for the most recent eight years. Secondly, demographics are driving medical services. More of the population is aging. People are living longer. And Medical technology is improving at a rate that provides new and better healthcare...

Amerigroup is but one example of the increased scrutiny being paid to Medicaid Health Plans following the FBI raid of Wellcare last year. Expect this to continue and have some volatility on Medicaid health plan performance. Some of this scrutiny may uncover material issues, or impact contracting and...