GLG News by Managed Care Pricing Trends Experts

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.

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...

Doctor Rating systems are here to stay and will play a greater role in contracting and patient decision making. Those that seek to disbelieve or dismiss these efforts may find themselves on the wrong end of this debate.  Even physician groups such as the American College of Surgeons and the American...

Regrettably, many physicians feel that dealing with dollars is less then fulfilling, especially in light of off-loading potential costs of defensive medicine.  The very turbulent times ahead will give employed groups of physicians a strategic advantage over individually fragmented doctors...

This article discussed the Federal investigation into payments made by orthopedic implant manufacturers and physicians who use these products. While there are certainly appropriate consulting arrangements, these can be easily abused and there will be more investigations, not just in ortho...