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.

The Most Difficult Part Of The Patient-Centered Medical Home

By Clive Riddle, July 31st, 2015

The medical home transformation for primary care, incorporating a team approach, technology, elements of care coordination and much more, has been a significant driver of change and innovation this decade. In the about to be released August issue of Medical Home News, the Thought Leaders Corner asks the question:  What was the most difficult part of the patient-centered medical home transformation that you experienced or observed? Here’s what the panel shared in their responses.............Click to continue

Snapshots of the Mega-Mergers

By Clive Riddle, July 24, 2015

With Anthem and Cigna’s merger announcement, the dance card has been filled out. Here’s what they had to say about their deal.............Click to continue

Accuracy of Provider Directories

By Claire Thayer, July 17, 2015

Beginning in 2016, health plans will face stiff penalties for failing update and monitor their provider directories. Kaiser Health News reports that inaccuracies in provider directories may trigger penalties of up to $25,000.............Click to continue

Nag On My Shoulder

By Kim Bellard, July 15, 2015

We seem to like to have help with our health. In addition to doctors, we might have a case manager, a health coach, a pharmacist, a personal trainer, or a nutritionist, to name a few.  But we soon may be able to have all of their expertise whispering in our ear 24/7.............Click to continue

How National Thought Leaders View The Post SCOTUS Public HIX World

By Clive Riddle, July 10, 2015

Earlier this month, Health Insurance Marketplace News published a supplemental edition of their newsletter, providing commentary from 27 ThoughtLeaders around the country at the SCOTUS King v Burwell decision. They were asked: “What’s your gut reaction to the ruling?.............Click to continue

Jurassic Park: Rise of the Health Insurers

By Kim Bellard, June 26, 2015

If you want to see dinosaurs fighting, stalking, and even mating, you don't need to go see Jurassic World.  Just pick up the business pages and see what is going on with the big health insurers, who seem intent on getting even bigger.

Whether anything actually comes of all the merger mania.............Click to continue

Some Things to Know and Ask in the Aftermath of the CVS/Target Deal

By Clive Riddle, June 19, 2015

Here’s some things to know in the aftermath of the announced CVS/Target deal . We can start with this list of deal points that the two companies provided in their press release announcing the acquisition and strategic partnership.............Click to continue

Health Plan Member Portals

By Claire Thayer, June 18, 2015

During the months of May and June, MCOL and LexisNexis conducted an e-poll of healthcare professionals on their involvement and insights with health plan member portals.  Respondents were categorized as Health Plan, Integrated delivery Network, Third Party Administrator (TPA), Self-Insured Employer, and Other. Overall, two thirds of the respondents indicated.............Click to continue

PwC and Milliman Examination of Medical Cost Trends

by Clive Riddle, June 10, 2015

PwC projects a medical cost trend for 2016 of 6.5%, netting down to 4.5% after benefit design changes. Milliman tells us that the 2015 actual trend was 6.3%, up from 5.4% in 2014.

PwC’s Health Research Institute this week released their tenth annual Behind the Numbers report, which includes a “projection for the coming year’s medical cost trend based on analysis of medical costs in the large employer insurance market.............Click to continue

Track 3 For Medicare ACOs

by Clive Riddle, June 5, 2015

CMS has just issued a 592 page MSSP ACO final rule resulting from their proposed rule issue in December, which received 275 stakeholder comments.

Here’s what CMS, in their own words, says the new final rule will accomplish.............Click to continue

Positive Trends in the Land of Retail and Workplace Clinics

By Clive Riddle, May 29, 2015

Last month, the Robert Wood Johnson Foundation commissioned Manatt Health to issue an excellent 25 page report:  The Value Proposition of Retail Clinics, in which they remind us that “since first emerging on the health care landscape more than 15 years ago, retail clinics are now a common feature.............Click to continue

Not One Penny More

By Kim Bellard, May 21, 2015

If you've been to a doctor's office or seen some other health care provider, chances are you've had to sign a patient consent form that, among other things, makes you promise that whatever they end up doing to you, and however much they choose to charge you for it, you're responsible for paying.............Click to continue

Impact of Stress on Health Risk

By Claire Thayer, May 20, 2015

Stress is prevalent, and at some point, all of us are faced with some type of stress in our lives.  What is considered as a stressful situation to one person may be inconsequential to another.  A recent WebMD study finds that 43% of all adults suffer adverse affects from stress. WebMD tells us that a little stress every now and then is not something to be concerned about. However.............Click to continue

Patient Reported Outcomes

By Clive Riddle, May 15, 2015

The National Quality Forum defines Patient-Reported Outcomes (PROs) as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else." They elaborate that “in other words, PRO tools measure what patients are able to do and how they feel by asking questions .............Click to continue

Annual Global Oncology Medicine Spending Tops $100 Billion

By Clive Riddle, May 7, 2015

The IMS Institute for Healthcare Informatics has just released a new report:  Developments in Cancer Treatments, Market Dynamics, Patient Access and Value: Global Oncology Trend Report 2015 which tells us.............Click to continue

Four Factors Fueling Demand for Telehealth

By Claire Thayer, May 7, 2015

Telehealth, as defined by the Health Resources and Services Administration, is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.............Click to continue

What are the implications of the upward spiral occurring in the specialty drug cost trend?

By Clive Riddle, May 1, 2015

What are the implications of the upward spiral occurring in the specialty drug cost trend?" That was the question asked of experts in the current issue in MCOL’s ThoughtLeaders. A running theme in their responses.............Click to continue

Does Patient Satisfaction Matter?

By Kim Bellard, April 24, 2015

In a provocative article for The Atlantic, Alexandra Robbins posits that we may have a "problem with satisfied patients."  Ah, only in health care.............Click to continue

Provider Networks Referral Leakage

By Claire Thayer, April 16, 2015

Containing patient referrals within a provider network is easier said than done, even with electronic health records.  According to Joel French, CEO of SCI Solutions, "more than 25 percent of orders and referrals from employed providers leak out of network."  Chief Financial Officers across the country cite referral leakage as a top concern. According to a recent survey, 51% of CFOs list reducing network leakage as the.............Click to continue

Vormetric Report: 48% of Healthcare organizations Had Data Breach or Failed Compliance Audit in Past Year

By Clive Riddle, April 16, 2015

Given the Anthem health plan hack in February, and other healthcare organizations that have fallen victim to breaches as of late, surveys offering threat assessments are certainly of interest. Vormetric just released the twenty-page 2015 Vormetric Insider Threat Report, which includes healthcare industry specific data.............Click to continue

Accenture Pegs 2015 Private Exchange Enrollment at 6 Million

By Clive Riddle, April 10, 2015

Accenture has released a new report on private exchange enrollment: Private Health Insurance Exchange Enrollment Doubled from 2014 to 2015, which pegs 2015 total private exhange enrollment at 6 million, up from 3 million in 2014.

Accenture forecasts that enrollment in private health insurance exchanges will grow to 12 million in 2016 and 22 million in 2017. They have gone on record projecting.............Click to continue

New Interactive Tool to Monitor U.S. Health Care Spending

By Claire Thayer, April 8, 2015

A week or so ago, The Peterson Center on Healthcare and the Kaiser Family Foundation unveiled a cool new interactive tool for public access to measure quality and cost components of the country's health care system on their new site, The Peterson-Kaiser Health System Tracker.  “This interactive tool provides up-to-date information on U.S. health spending by federal and local governments, private companies, and individuals.............Click to continue

Healthcare Startups Capitalizing on the Sharing Economy and More

By Clive Riddle, April 1, 2015

These five healthcare lists – courtesy of healthsprocket - should be of great interest today –addressing the sharing economy; King v Burwell; upcoming M&A transactions; headlines you might have missed; and hot innovation initiatives.............Click to continue

Looking for the Future in the Past

By Kim Bellard, March 25, 2015

I don't get smartwatches.

Yes, I know; they're all the rage. Apple unveiled its Apple Watch earlier this month, to generally good if not entirely ecstatic reviews. Not to be outdone, Google announced a collaboration with TAG Heuer and Intel for a "Swiss Smartwatch." Samsung and Sony are close behind with their own version.............Click to continue

PwC’s Health Research Institute Gives Us Five

By Clive Riddle, March 20, 2015

Many institutions are pausing to write and reflect on the ACA at this five-year anniversary mark, underneath the pall of the SCOTUS’ King vs. Burwell shadow. PwC’s Health Research Institute has just weighed in with a nice 22-page report : Healthcare reform: Five trends to watch as the Affordable Care Act turns five.............Click to continue

Prescription Costs Returning to the Wild

By Clive Riddle, March 13, 2015

Numerous studies have been warning that prescription cost increases, domesticated and docile for some time now, have returned to the wild - resurging and rearing their unpleasant head.

During last fall, Evaluate published a new 18-page report , "Budget-busters: The Shift to High-Priced Innovator Drugs in the USA." that addresses the growth of high-end prescription drugs. Evaluate tells us.............Click to continue

Medical Identity Theft Impact on Health Care

By Claire Thayer, March 12, 2015

According to findings from The Fifth Annual Study on Medical Identity Theft, published by the Medical Identity Fraud Alliance, the number of patients affected by medical identity theft increased nearly 22 percent in the last year, an increase of close to half a million since 2013.............Click to continue

Medicare Obesity Counseling – it’s Free!

By Claire Thayer, March 5, 2015

The Center for Disease Control and Prevention shows alarming obesity trend rates among the elderly population within the United States.  Thirty-six percent of men aged 65-74 are considered obese, along with slightly over 44% of women in this same age bracket, as highlighted on the CDC’s FastStats for Older Persons’ Health web page.............Click to continue

2015 – Another Year of Uncertainty?

By Cathy Eddy, February 25, 2015

This year on March 23, we will mark the 5th anniversary of the passage of the Affordable Care Act. Typically, you would expect that most of the unknowns that go along with a new law would have been worked out by now. Yet as we look ahead, we have several key elements that may change. There are also other drivers that are challenging our health plans.

Here are some of the uncertainties still ahead.............Click to continue

How the Mighty Haven't Fallen

By Kim Bellard, February 17, 2015

I recently read an article that speculated on how even the mighty Google could fade into irrelevance faster than we might think.  It made me wonder why that kind of change doesn't seem to happen in health care.............Click to continue

Are the Health Coverage and Tax Credit Details for Filing 1040s Really That Complex?

By Clive Riddle, February 12, 2015

Much attention has been given this tax season to the new intricacies involved with filing health coverage and related tax credit information for individual 1040s. H&R Block and many other tax services have taken the opportunity to nationally advertise their expertise to support tax filers this season.

So the question begs, how complex are they.............Click to continue

Predictable savings when health plan members are engaged in preventative care

By Claire Thayer, February 12, 2015

There are many approaches to patient care intervention, in terms of managing chronic disease. Several years ago an important study, that is still widely referenced, finds that some of the most successful patient care intervention approaches include those that are customized for each individual patient, allow for.............Click to continue

Analysis of Managed Care Organization CEO Turnover Rates

By Clive Riddle, February 6, 2015

MCOL has just conducted an analysis of managed care organization CEO turnover during the past ten years, and found the turnover rates to be surprisingly high, given the importance of management stability and continuity for most organizations. One-fourth of managed care organization CEOs turned over during the past year,  one-third turned over during the past two years, one-half turned over during.............Click to continue

The Value of Maternity Management in Mitigating Legal Risk

By Claire Thayer, February 4, 2015

Almost 85% of women in the U.S. receive maternity services when giving birth. According to a report presented by Childbirth Connection, "Maternity Care and Liability: Pressing Problems, Substantive Solutions," childbirth is the nation's leading reason for hospitalization and most expensive hospital condition. It is also estimated that 19 of 3,000 hospital births result in an adverse outcome. The importance of maternity management in mitigating legal risk is the focus of MCOL's infoGraphoid.............Click to continue

Ranking the Seahawk’s Seattle vs. the Patriot’s Boston in the Health Care Bowl

By Clive Riddle, January 30, 2015

Given that the contest between the Seattle Seahawks  vs. the New England Patriots in Super Bowl XLIX is a product of listing and ranking NFL teams (by wins and losses), perhaps some irrelevant insights into the outcome of that contest can be gleaned by comparing how the two cities rank in various healthcare lists.............Click to continue

Population Health Management - Integration of Medical and Pharmacy Benefits

By Claire Thayer, January 22, 2015

A new Blue Cross Blue Shield Association (BCBSA) and Prime Therapeutics LLC (Prime) study examined yearly medical costs of 1.8 million members of Blue Cross® and Blue Shield® (BCBS) independent companies, whose pharmacy benefit services were divided between “carve-in” and “carve-out” benefit options.  This study finds.............Click to continue

Making the Old New Again

By Kim Bellard, January 22, 2015

I always love it when someone looks at something familiar in a completely new way.  I only wish health care had more examples of that.

The example of this kind of totally fresh thinking that caught my eye concerns traffic lights.  If researchers from Carnegie Mellon University, led by Professor Ozan Tonguz, have their way, those familiar yellow boxes with the lights could become unnecessary.............Click to continue

What exactly is Qliance?

By Clive Riddle, January 16, 2015

Qliance, recently discussed in Time Magazine as they are quick to tell you, just issued a news release  that their New Primary Care Model Delivers 20 Percent Lower Overall Healthcare Costs, Increases Patient Satisfaction and Delivers Better Care.

Qliance conducted a study "of insurance claims data from 2013 and 2014 for approximately 4,000 Qliance patients covered by employer benefit plans, and compared the cost of their care to that of non-Qliance patients who worked for the same employers..."..........Click to continue

Your Healthcare Lexicon for 2015 from A to Z

by Clive Riddle, January 9, 2015

Accountable Care Arrangements in Medicare, Commercial and Medicaid flavors

Big Data in healthcare parsed with Analytics

Collaboration.............Click to continue

The Convenience Truth

By Kim Bellard, December 17, 2014

The U.S. Mint reports that it now costs 1.7 cents to make a penny; nickels are slightly better, costing "only" 8 cents to make the 5 cent coin.  This is economics the way health care practices it.............Click to continue

Pitfalls with Health Care Provider Data

By Claire Thayer, December 11, 2014

A U.S. Senate Committee investigation report finds that Medicare paid 478,500 claims attributed to deceased physicians, totaling up to $92 million, from 2000 to 2007. The U.S. Postal Service reports that at least 25-30% of the demographic and contact information for health care providers changes every year. The cost of bad or outdated provider data is estimated at $26 billion annually.............Click to continue

The Age of Discontinuity

By Cathy Eddy, December 8, 2014

On December 2, I was invited to be on a panel at a Health Care Executive Forum in Washington DC that was sponsored by the Academy of Managed Care Pharmacy. David Nash, MD, MBA, dean of the Jefferson School of Population Health facilitated discussions about.............Click to continue

What’s In a Name?

By Clive Riddle, December 3, 2014

Wellpoint is now Anthem. The re-titling of the national health benefits company was publicly announced months ago, the new corporate website has been designated as www.antheminc.com, and the change from the New York Stock Exchange ticker from WLP to ANTM became effective today.  

WellPoint Health Networks and Anthem merged in 2004, with WellPoint assuming the corporate name of the merged company. Why the name change back to Anthem ten years later?.............Click to continue

Future of Provider-Sponsored Health Plans and Managing Risk

By Cathy Eddy, December 1, 2014

Deloitte Consulting conducts an enterprise wide risk assessment with Presbyterian Health Services annually and the information is leveraged by the health plan.

Health systems are looking at their range of options for the future – most with an eye for making the transition from fee-for-service to value-based reimbursement. These options include.............Click to continue

Lung Cancer Misperceptions: The “Any One Any Lung” Survey

By Clive Riddle, November 21, 2014

Misperception surrounding a disease can impact treatment, care, funding, and more. So it would seem is the case with lung cancer, as just highlighted in a new survey “Any One Any Lung” Survey sponsored by Novartis Oncology. The online survey was conducted by Harris Poll involving 10,111 adults from 10 countries including the U.S..............Click to continue

Health Care Fraud Detection: Intersection of Data and Linking Analytics

By Claire Thayer, November 19, 2014

LexisNexis tells us that three key elements of successful link analysis are Big Data, Super Computing and Social Network Definition and that the three big data necessary for successful link analysis include claims data, provider data and member data.  In August earlier this year, LexisNexis hosted a webinar, Moving Fraud Prevention Forward: The Intersection of Data and Linking Analytics.  Throughout this webinar, the audience engaged in several polling questions - these questions, along with the audience responses are featured in MCOL’s infoGraphoid this week.............Click to continue

The Future Is Still Not Here

By Kim Bellard, November 13, 2014

US News & World Report had some fun looking back at what experts in 2004 predicted for health care in 2014.  Not surprisingly, they found that we're not quite there yet, but might be by 2025.  The future, it would appear, is always ten years away. 

Those 2004 pundits expected that health care would be one of the industries most impacted in these past ten years; specifically.............Click to continue

Healthcare Innovation Models and Accelerators

By Clive Riddle, November 7, 2014

Intermountain Healthcare and Healthbox just announced an interesting healthcare innovation collaboration, with their Innovation at Intermountain Healthcare Initiative. Intermountain is the Utah-based health system non-profit juggernaut with 22 hospitals, 185 clinics, 1,100 employed physicians, and the SelectHealth health plan.............Click to continue

US Healthcare Spending Waste, Unnecessary Cost, and Fraud

By Claire Thayer, November 5, 2014

The United States spends almost $3.8 trillion annually on healthcare – or 18% of GDP. Of this amount, almost one-third of healthcare spending is estimated to be attributed with waste, unnecessary services and fraud. MCOL’s infoGraphoid this week highlights some of the major types of waste.............Click to continue

Top Ten Medical Innovations for 2015

By Clive Riddle, October 31st, 2014

The Cleveland Clinic annually announces their take on the Top Ten Medical Innovations that are likely to have major impact on improving patient care in the coming year. They have just released their ninth annual version of this list.............Click to continue

Google Wants to Helpout Your Health

by Kim Bellard, October 21, 2014

I suppose it was inevitable that I'd end up writing something about Google's interest in health, since recent posts have focused on efforts from Facebook and Amazon, as well as the general gold rush for health IT.  Fortunately Google has obliged me by introducing a neat health-related wrinkle on their Helpouts service.............Click to continue

Previous Posts...

MCOLBlog Team

Kim Bellard
KB Consulting
Columbus, OH

Krista Burris
Healthcare Strategy Consultant
San Francisco Bay Area


William DeMarco
DeMarco and Associates
Rockford, IL


Cathy K. Eddy
Health Plan Alliance
Irving, Texas


Laurie Gelb
Vice President
ORC International
Seattle, WA

Nate Kaufman
Managing Director
Kaufman Strategic Advisors
San Diego, CA

Cyndy Nayer
Founder and CEO
Cyndy Nayer's Center of Health Engagement

Lindsay Resnick
Chief Marketing Officer
KBM Group: Health Services

Clive Riddle
Modesto, CA

Marshall Riddle
Senior Analyst
Modesto, CA

Claire Thayer
Vice President
Business Development
Portland, OR

Paul Vogelzang
Social Media Expert
Falls Church, VA