Welcome to the MCOL Blog
Please join the discussion with our panel of experts, as we cover a wide range of important topics shaping the business and future of health care.
Uberization of Nursing
By Dr. Seleem R. Choudhury, June 23, 2022
“Uberization" is a catchphrase that has quickly become part of common parlance in discussions about the pandemic-induced economy. Uberization is the movement by organizations to “replace fixed wage contracts with ‘dynamic pricing’ for...continued
I Want to Believe
By Kim Bellard, May 26, 2022
I know, I should be writing about hot topics like monkeypox or the baby formula shortage, but, c’mon, Congress held hearings last week about UFOs — the first in 50 years! I mean, I followed Project Blue Book in the 1970’s, watched ...continued
Examining Unnecessary Medicare Patient Surgeries During First Year of Pandemic
By MCOL Staff, May 20, 2022
The nation’s hospitals performed more than 100,000 unnecessary and potentially harmful procedures on older patients between March and December 2020, according to a new analysis by the Lown Institute, a healthcare think tank. Coronary stents and back surgeries were ...continued
What do Copernicus and Today’s Healthcare Leaders Have in Common?
By Maria D. Moen, May 13, 2022
Both Use Data to Change the World as We Know It. In 1543, Copernicus was the first astronomer to propose the theory that the earth and other planets rotated around the sun, which contradicted popular thought at the time that the earth was the center of the universe. Through...continued
Scaling the Mountain of Pain Management: Why Virtual Reality is the New Pathway
By Gerry Stanley, M.D., May 5, 2022
There may be many ways to summit Mount Everest, but the safest route is to follow an established path with the help of a seasoned guide. The same advice holds true for exploring the latest and most promising innovation for treating patients suffering...continued
We Love Innovation. Don’t We?
By Kim Bellard, April 22, 2022
America loves innovation. We prize creativity. We honor inventors. We are the nation of Thomas Edison, Henry Ford, Jonas Salk, Steve Jobs, and Stephen Spielberg, to name a few luminaries. Our intellectual property protection for all that innovation is the...continued
Value-Based Care and Care Coordination: Five Key Takeaways from WakeMed Key Community Care and UC San Diego Health
by Claire Thayer, April 12, 2022
Healthcare organizations face increasing pressures to meet demands of population health and effective care management. Recently, we hosted a panel discussion webinar, co-sponsored by MCG Health, that identified ...continued
Catching up with Advisory Board’s Ken Leonczyk on the State of the Health Plan Industry and what health plan leaders need to know for 2022
by Claire Thayer, April 11, 2022
The pandemic has had a significant impact on health plans and in many ways has been a catalyst for change across the healthcare industry. Recently, Ken Leonczyk, Executive Partner, Advisory joined us for a lively...continued
Spring is Here and Medicare Advantage is in Full Bloom
by MCOL Staff, April 7, 2022
Mark Farrah Associates has released their assessment of Medicare Advantage and Prescription Drug Plan performance, market share and market penetration as of March, 2022. They report that total MA membership exceeded 29.4 million and ...continued
Strategic Prioritization and Deselection: Being transformative in the beginning stages of an endemic
by Dr. Seleem R. Choudhury, March 31, 2022
On the cusp of entering an endemic state, organizations are deciding what to turn their attention to “after COVID.” Wise leaders will recognize that this is not as simple as carrying on with their pre-COVID strategies. No organization has been...continued
ARPA-H Needs to Think Bigger
by Kim Bellard, March 25, 2022
Everyone loves DARPA, the Defense Advanced Research Projects Agency that is credited with such hits as the internet and GPS, but is also responsible for things like the Boston Dynamics back-flipping robots and even...continued
The Continuing Relevance and State of Medigap Plans
by Clive Riddle, March 18, 2022
With such focus in Medicare-World on Medicare Advantage plans, its easy to forget that the continuing relevance of Medigap plans. While there are close to 24 million covered in MA plans, another 14.4 million have Medigap coverage. AHIP’s Center ...continued
Google’s Alphabet, Facebook’s Meta, and now Anthem’s Elevance
by Clive Riddle, March 10, 2022
In 2015 Google unveiled Alphabet, a new name to brand the parent holding company separate from the Google identity. Last year, Facebook announced Meta in a similar fashion. And now, 2,306 miles from Silicon Valley, an announcement emerges from Indianapolis...continued
What’s Next for Medicare Advantage: Part II - Next Up: Time To Get Real
by Lindsay Resnick, March 2, 2022
Whether called ‘keys to success’ or ‘make it or break it time’ the following five challenges and opportunities are real. To be competitive in tomorrow’s Medicare Advantage marketplace plans need strategies for...continued
Get Ready for (Healthcare) Microgrids
By Kim Bellard, February 24, 2022
We depend on it. Indeed, our daily lives are unimaginable without it. The trouble is, it’s become unreliable. Lives have been lost because it wasn’t performing when it needed to be. It’s built around large facilities that are often...continued
What’s Next for Medicare Advantage: Part I - Frontline: Lessons Learned
By Lindsay Resnick, February 17, 2022
As its 20th anniversary quickly approaches, Medicare Advantage has surpassed 28 million members. 46% of eligible Medicare beneficiaries now choose an MA plan. The average Medicare beneficiary has access to over 40 plan options, many providing...continued
Platform mutual aid for healthcare coverage in China
by Rong Yi, Milliman, February 10, 2022
Since 2012, China has achieved near-universal health coverage through a set of sweeping national health reforms. The basic social health insurance mostly covers inpatient services. Outpatient and prescription drug coverage are not yet standardized within ...continued
COVID in 2022: Key Components of Moving to an Endemic State
by Dr. Seleem R. Choudhury, February 3, 2022
During this current winter wave, many countries outside the U.S. continue to use blunt COVID mitigation measures that they relied on early in the pandemic. These measures, such as transitioning kids to at-home learning and closing businesses, resulted in ...continued
The Tests Were a Test
by Kim Bellard, January 28, 2022
Raise your hand if you’ve gone out shopping for home COVID tests, only to find empty shelves and signs apologizing for the lack of availability. Raise your hand if you’ve been able to obtain one, but were surprised at its cost. Raise your hand if ...continued
The Big Picture: Healthcare 2022 - Trends, Predictions Challenges & Opportunities
by Lindsay Resnick, January 20, 2022
Health brands are jumping on the transformation bandwagon. We need to change. We need to modernize. The health sector needs to reimagine itself. And needs to do it around the customer. This collection of curated factoids can help ...continued
Five Healthcare Prognosticators That Resonated for 2022
By Clive Riddle, January 13, 2022
We recently provided our own view into 2022, Scrolling Through the Roadmap of 2022 Healthcare Trends, With Sixteen Selected Stops. Now we’ve scrolled even further to see what others are saying about the coming year in healthcareland. We found...continued
Scrolling Through the Roadmap of 2022 Healthcare Trends, With Sixteen Selected Stops
By Clive Riddle, January 6, 2022
2022 will offer a complex, challenge-filled healthcare landscape, that can’t be navigated with a roadmap viewable on a device screen without a whole lot of scrolling involved. So get ready to slide your finger or mouse downward ...continued
The Eisenhower Principle
By Kim Bellard, December 17, 2021
I’ve finally come to understand why the U.S. healthcare system continues to be such a mess, and I have President Dwight Eisenhower to thank. I’ve been paying close attention to our healthcare system for, I hate to admit...continued
The State of Telehealth as We Slide into 2022
by Clive Riddle, December 10, 2021
A HHS 34-page study released this week by ASPE (Office of the Secretary for Planning and Evaluation) entitled Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location says the bottom line on telehealth...continued
A Mission Statement Must Be More Than a PR Tactic
By Dr. Seleem R. Choudhury, December 2, 2021
Each one of us has deeply held beliefs that motivate us to action. This is part of what it is to be human. It is embedded in our humanity to pursue virtue, or a habitual and firm disposition to do good. Our character is inextricably linked with virtue, because...continued
Breaking Up Is Good to Do
By Kim Bellard, November 16, 2021
Last week General Electric announced it was breaking itself up. GE is an American icon, part of America’s industrial landscape for the last 129 years, but the 21st century has not been kind to it. The breakup didn’t come as a complete surprise. Then later in the week ...continued
A Trio of Value Based Care Surveys Indicate Technology Opportunities to Address Administrative Challenges
By Clive Riddle, November 10, 2021
The Guidehouse Center for Health Insights has just released analysis of an executive survey in conjunction with HFMA, the 2021 Risk-Based Healthcare Market Trends, that found health systems appear to be going big into ...continued
Dental and Vision Plan Satisfaction in 2021
By Clive Riddle, November 4, 2021
It’s time to see things eye-to-eye, and tell the tooth, about the state of vision and dental plan satisfaction. Setting Dad jokes aside, J.D. Power has just separately released their 2021 U.S. Dental Plan Satisfaction Report and their ...continued
Medicine May Be an Art, But AI May Be Artists
By Kim Bellard, October 28, 2021
Six hundred years ago, Swiss physician/scientist/philosopher Paracelsus disclaimed: “Medicine is not only a science; it is also an art.” Medicine, most people in healthcare still believe, takes not just intelligence and fact-based decision-making, but also ...continued
What Collaborative Health Systems, athenahealth and Milliman Found, Sifting Through CMS ACO Performance Data
By Clive Riddle, October 22, 2021
Collaborative Health Systems has announced their affiliate Accountable Care Coalition (ACC) of Southeast Texas, Inc. generated nearly $64 million in shared savings under the Next Generation Accountable Care Organization (ACO) Model...continued
Developing Excellence in Primary Care
By Dr. Seleem R. Choudhury, October 13, 2021
Nearly half of all Americans suffer from at least one chronic disease, and that number is growing . Chronic diseases—including cancer, diabetes, hypertension, stroke, heart disease, respiratory diseases, arthritis, obesity, and oral diseases—can lead to...continued
A Nice Development in HDHPs: More Reduced Cost Sharing For Targeted Conditions
By Clive Riddle, October 7, 2021
AHIP and the Smarter Health Care Coalition have released survey results that found ‘most health insurance providers and many large employers have taken advantage of new regulatory flexibility to cover more chronic disease prevention services on a pre-deductible...continued
The Latest No Surprises Act Interim Rule and the Ignored Problem of Hospital Based Physicians
By Clive Riddle, September 30, 2021
A second interim final rule for the No Surprises Act: “Requirements Related to Surprise Billing; Part II,” has just been issued, which CMS has summarized as including the following provisions: A process that takes consumers ...continued
Not Your Father's Job Market
By Kim Bellard, September 24, 2021
If you, like me, continue to think that TikTok is mostly about dumb stunts, or, more charitably, as an unexpected platform for social activism, you probably also missed that TikTok thinks it could take on LinkedIn. Welcome to ...continued
On the Journey of Cost Containment - China’s DRG Development and Implementation
By Rong Yi and Wendy Liu, September 16, 2021
Diagnosis Related Groups (DRGs) was first introduced in the US in the 1980s as a payment methodology for Medicare. After decades of development, implementation and operational improvement, it remains one of the most dominant payment mechanisms by ...continued
Telehealth Going Forward: More Measured, and Featuring Primary Care, Behavioral Health and Chronic Care
By Clive Riddle, September 10, 2021
The Center for Connected Medicine has just released a new report conducted in partnership with KLAS Research: The Intersection of Value and Telehealth: Survey Findings on Adoption and Utilization, which tells us that ...continued
The 2021 Medicare Trust Fund Report by The Numbers
By Clive Riddle, September 2, 2021
What is the state of the Medicare Trust Fund, by the numbers? $900 billion in income and $926 billion in expenditures provided for the 62.6 million Medicare beneficiaries, with the Part A fund projected to be ...continued
I Am Dr. Groot
By Kim Bellard, August 26, 2021
All I can think about is robots. Most of the recent publicity about robots has come from Elon Musk’s announcement of the Tesla Bot, or the new video of Boston Dynamic’s Atlas doing more amazing acrobatics, but I was more intrigued by ...continued
Utilization Drop in 2020 May Have Not Been as Much as Feared, and 2021 May be Seeing a Spike
By Clive Riddle, August 19, 2021
Analysis of California Health Plan data indicates 2020 physician encounters and inpatient days didn’t plummet as far as some worried earlier in the pandemic, due to deferred care, although as all aspects of everyday like opened up more in 2021, a spike in utilization...continued
China’s Commercial Health Insurance Market
By Rong Yi, PhD, Principal, China Healthcare Analytics Practice, Milliman, Inc.; August 10, 2021
China is large and complex economically, demographically, and geographically, and is also going through rapid changes at paces rarely seen in history. In this blogpost we provide a very high-level overview of China’s rapidly growing commercial health insurance market....continued
Optimizing Post-Acute Care Management: Four Key Takeaways from MCG Health Experts
By Claire Thayer, August 4, 2021
Recently, MCG Health’s Suzanne Doran, Managing Editor and Emily Ferguson, Associate Managing Editor, joined us in a webinar discussion on ways to engage patients, identify social determinants of health, and ultimately improve health outcomes while...continued
The Most Important Thing
By Kim Bellard, July 26, 2021
Jack Dorsey has some big hopes for bitcoin. In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.” The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business...continued
Life Expectancy at Birth in 2020: One Simple Number for COVID-Deniers
By Clive Riddle, July 23, 2021
Deniers of COVID-19's impact - sadly numbering in the millions - posted on social media in droves during the past year that COVID-19 deaths were vastly overstated because they were attributed to other actual causes of death. Countless reports on excess mortality...continued
Postcards From the Drug Pricing Trail
By Clive Riddle, July 16, 2021
President Biden’s recently released Executive Order on Promoting Competition in the American Economy included provisions regarding prescription drugs, first stating that “Americans pay more than 2.5 times as much for the same prescription drugs ...continued
The Necessary Insecurity of Healthcare Leadership
By Dr. Seleem R. Choudhury, July 8, 2021
Years ago, I accepted a job even though I was told that the team I was to lead didn’t want me as their leader. During my tenure, I received anonymous threats to leave, as well as episodes of sabotage and unhelpful behavior. Despite this, I was convinced that I could...continued
Go Ahead, A.I. — Surprise Us
By Kim Bellard, June 29, 2021
Last week I was on a fun podcast with a bunch of people who were, as usual, smarter than me, and, in particular, more knowledgeable about one of my favorite topics — artificial intelligence (A.I.), particularly for healthcare. With the WHO releasing ...continued
Addressing Mental Health Requires Greater Focus on the Workplace
by Clive Riddle, June 25, 2021
Perhaps no aspect of healthcare is more intertwined with the workplace than mental health. In Health Affairs this week, Amanda Goorin, Richard G. Frank, and Sherry Glied in their post: Addressing Mental Illness Requires Workplace Policy As Well As Health Care Policy, frame ...continued
Chinese Healthcare and More with Rong Yi
by Clive Riddle, June 16, 2021
MCOL is very excited and please to be welcoming Dr. Rong Yi as a contributor to mcolblog. She is the principal responsible for Milliman’s Greater China Healthcare Analytics Practice, and will be be discussing Chinese Healthcare and more in future periodic posts. We have just ...continued
Five Questions for Provider Data Experts on the No Surprise Act
by Claire Thayer, June 11, 2021
Recently, LexisNexis Risk Solution’s John Markoff, Senior Director, Provider Data Strategy and Laura Long, Vertical Solutions Consultant, Provider Data joined us in a webinar discussion on the new provider directory accuracy requirements that go into effect ...continued
Upswing in Medicare Telehealth Awareness and Use: What Will Be Post-Pandemic Policy?
By Clive Riddle, June 3, 2021
Recent reports indicate that even for the supposedly more tech-phobic Medicare population, telehealth awareness and utilization caught on during the pandemic, and the GAO has some concerns about that. The big question is, what are the ...continued
Holograms to the Rescue
By Kim Bellard, May 26, 2021
Google is getting much (deserved) publicity for its Project Starline, announced at last week’s I/O conference. Project Starline is a new 3D video chat capability that promises to make your Zoom experience seem even more tedious. That’s great, but I’m expecting ...continued
Patients Want Two “T”s From Providers: Telehealth and Texting
By Clive Riddle, May 20, 2021
Results from two surveys were released this week on what U.S. patients want in their provider communications: telehealth and texting. Harris Poll, on behalf of NextGen Healthcare, found that 53 percent "say the pandemic changed how they want to...continued
COVID Wars: Attack of the Variants
By Dr. Seleem R. Choudhury, May 14, 2021
As an increasing portion of the global population continues to receive the COVID vaccine, public health experts, government officials, and healthcare professionals continue to monitor variants emerging around the world. With recent spikes of infections in India ...continued
Pulse of Payers on No Surprises Act
By Clive Riddle, May 7, 2021
How are health plans and other purchasers feeling about facing the No Surprises Act at this juncture - with the ACT taking effect January 1, 2022 - ? Zelis recently conducted a survey "of 116 healthcare payer executives ...continued
Healthcare’s Million Dollar Blocks
By Kim Bellard, April 28, 2021
Since I first heard about them, I have been fascinated, and dismayed, by the concept of “million dollar blocks.” For those of you unfamiliar with the term, it doesn’t refer to, say, Beverly Hills. No, it refers to city blocks for which society spends over a million dollars annually to ...continued
COVID-19 Vaccine Incentives: CMS Guidance Needed to Help Medicaid Programs Go Further
By Clive Riddle, April 23, 2021
A major worry is that COVID-19 vaccine takeup, which had been rocketing upward, may now have reach a plateau. Here’s how the Kaiser Family Foundation frames the situation: “Broadly, the COVID-19 Vaccine Monitor has found that vaccine confidence...continued
Organizational culture change as renovation, not demolition
By Dr. Seleem R. Choudhury, April 15, 2021
An organization’s “culture” is simply defined as the expected way to behave within an organization. Stated more simply, organizational culture is “the way things are done around here” (Deal & Kennedy, 2000). Culture is not written rules or guidelines, but rather ...continued
Springtime in Medicare Advantage Land
By Clive Riddle, April 9, 2021
The seeds are planted in the fall. Then as Spring arrives, you can assess what has been sowed. Or, as Mark Farrah Associates puts it: “Health insurers compete by offering new pricing and product options to beneficiaries during the Open Enrollment ...continued
Tracking COVID-19 Vaccination Enthusiasm and Hesitancy
By Clive Riddle, April 2, 2021
The monthly Kaiser Family Foundation COVID-19 Vaccine Monitor report released this week "finds enthusiasm for getting a COVID-19 vaccine continuing to grow, with roughly 6 in 10 adults (61%) now saying they have already ...continued
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