Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

The Department of Defense contracts with more than 11,000 health care professionals, at an annual cost of about $1 billion. A recent Government Accountability Office report says the military could do more to coordinate its contracting duties to save money and avoid duplication. Military Health Spending: The Military Health System provides...
Primary care is shifting to payment based on providing higher quality, lower cost health care. New payment models - such as patient-centered medical homes (PCMH) - replace or supplement traditional fee-for-service payments with per-member per-month payments, and emphasize coordinated care, quality measurement, and accountability. Some models offer cost-sharing, as...
In recent testimony to the Senate Finance Committee, Gary Cohen of the Centers for Medicare and Medicaid Services (CMS) gave an update of progress on Health Insurance Exchanges (HIX) implementation, now called Health Insurance Marketplaces. There is plenty to do, as shown in the timeline CMS presented that day,...
A painful fact about the U.S. health system is that roughly one third of health costs and spending are wasted. A study in the Journal of the American Medical Association (JAMA) found that wasted health spending could reach from about $500 billion to almost $1 trillion each year. And...
Patents form the basis of the  pharma and biotech industry, also called the life sciences industry. They give companies an incentive to make large investments in risky drug development and innovations, which have the potential to be ineffective or to fail Food and Drug Administration (FDA) approval. More than 6,000 U.S. businesses spent...
State insurance commissioners typically bear most of the responsibility for enforcing health insurance consumer protections. In theory, that will remain the case after broad new consumer protections included in the Affordable Care Act (ACA) go into effect. States are expected to be the first-line of enforcement, and the federal...
Generic drugs have operated under a different set of rules than brand-name drugs since 1984, when Congress passed the Drug Price Competition and Patent Term Restoration Act of 1984, or Hatch-Waxman Act. Brand-name drug manufacturers must submit extensive evidence from clinical trials to get approval from the Food and...
The 2012 Supreme Court got a lot of attention for its decision to uphold most of the Affordable Care Act (ACA) health reform law in NFIB v. Sebelius. But this year’s court docket will be no dud. There will be a number of interesting and important cases for pharma...
Essential health benefits (EHB) will play a fundamental role in shaping health plans after 2014. Part of the Affordable Care Act (ACA), EHBs define a baseline of 10 types of services those plans must cover, including prescription drugs, hospital services, preventive or wellness services, and chronic disease management. Qualified...
Opaque prices – the norm in U.S. health care – in a key driver of inefficient, ineffective medical care and rapid cost increases.  Transparency of health care prices - public reporting of prices - is an essential ingredient for a high-value, cost effective health care system. In recent years, rising...

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