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 Prescription Drug Locomotive and the U.S Big Slice of the Global Rx Pie

by Clive Riddle, November 20, 2015

With prescription drug spending now having taken over the locomotive of the healthcare cost train, it behooves stakeholders to better get to know what lies on the tracks ahead. The IMS Institute for Healthcare Informatics has just released the 47-page report: Global Medicines Use in 2020:  Outlook and Implications in which they examine the global use of medicines and spending levels in 2020.............Click to continue

The Impact of Inaccurate Patient Data

By Claire Thayer, November 18, 2015

Matching of patient records to the correct person is of utmost importance in terms of patient safety and quality of care, yet gets complicated when organizations share their records electronically either with different EHR platforms or across multiple healthcare systems as well as when patients use different settings to receive their car.............Click to continue

Someone Must Be On Drugs

By Kim Bellard, November 11, 2015

As is probably true for many of you, I'm busy looking at health plan open enrollment options for 2016. The past few years I've been guilty of just sticking with the same plan, so it has been too long since I've had to shop. Plus, I'm helping my mother pick her Medicare options for next year. All in all, I'm awash with health plan options.............Click to continue

Juggling Risk

By Cathy Eddy, Health Plan Alliance, November 4, 2015

The insurance industry is based on managing risk. Health insurance has managed medical costs for years. With the Affordable Care Act, the federal government has set a minimum target for the medical loss ratio at 80-85%.

But managing risk has become so much more challenging for the health care industry than just managing medical claims. We are now juggling.............Click to continue

A Definitive Study and Reference Resource on Healthcare Cost and Utilization

By Clive Riddle, October 30, 2014

The Health Care Cost Institute (HCCI) has just released its free 26-page 2014 Health Care Cost and Utilization Report, and 92-page Appendix, which provide a definitive examination of detailed U.S. health care cost and utilization component line items and demographics. Their study – as with other major cost studies released this year – put a lot of focus on increases in prescription drug prices.............Click to continue

I'm Shocked, Shocked

By Kim Bellard, October 22, 2015

Some new research on the effect of physician practice arrangement has on spending offer some disappointing -- but not entirely surprising -- results.

Take physician groups. The death of the independent physician practice, working solo or in a small practice, has long been predicted. Honestly: would you rather.............Click to continue

Transitioning payer reimbursement from volume to value

By Claire Thayer, October 20, 2015

Moving away from traditional reimbursement models based on volume to those aligned more closely with outcomes, cost and quality is easier said than done, but has over-whelming industry support.  Earlier this year, Modern Healthcare spoke with committee members of a new Health Care Transformation Task Force.............Click to continue

The Nexus of Payviders

by Clive Riddle, October 9, 2015

To what degree will the mega-merged health plans dominate the landscape in the balance of this decade? We’ve recently discussed the topic: will health plan start ups and provider sponsored plans fill the competition gap? We noted then, that the airline industry demonstrated opportunities that might apply in the current health plan environment, .............Click to continue

Consumers and Physicians and Technology in 2015

by Clive Riddle, October 9, 2015

The Deloitte Center for Health Solutions has just released a survey report, Health Care Consumer Engagement: No One-Size-Fits-All Approach, which they say shows 'that Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles in acting like consumers instead of passive patients.".............Click to continue

The Patient Experience of the Very Elderly

by Clive Riddle, October 2, 2015

Press Ganey has just published a seven page white paper Patient Experience in the Very Elderly: An Emerging Strategic Focus, that in their words, “examines the clinical and strategic benefits for health care organizations creating targeted care strategies for the ‘Very Elderly’ population” which they  define as patients 80 years of age and older.............Click to continue

Can Slick Trump Sick?

By Kim Bellard, September 24, 2015

Health insurance is getting some love from investors.  A lot of that money is going to companies that make it easier to deal with health insurance, but some is going to start-ups -- like OscarClover Health, and Zoom+ -- that actually hope to reinvent the nitty-gritty, often grimy business of providing health insurance..............Click to continue

Will Health Plan Start Ups and Provider Sponsored Plans Fill the Competition Gap?

By Clive Riddle, September 18, 2015

The AMA recently released a special analyses of commercial health insurance markets that found the "combined impact of proposed mergers among four of the nation's largest health insurance companies would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states," and that "all told, the two mergers would diminish competition in up to 154 metropolitan areas within 23 states.".............Click to continue

Public Exchange Subsidies – A Snapshot with Distant Clouds

By Clive Riddle, September 11, 2015

Two item of note occurred this week with respect to public exchange subsidies and enrollment: CMS released their June 30, 2015 Effectuated Enrollment Snapshot, and federal judge Rosemary Collyer in an unprecendented ruling that congress has standing for litigation, has allowed United States House of Representatives v. Burwell et al, U.S. District Court for the District of Columbia, No 14-1967 to move forward.

So the attempts.............Click to continue

A Quick Look at Provider Billing Facts

By Claire Thayer, September 9, 2015

In 2014, the U.S. health care system spent close to $1 trillion on health care, with half of this paid to hospitals, a third toward physicians and clinical services and the remainder on prescription drug spending. Over the next 10 years, CMS projects that health spending will.............Click to continue

Cadillac tax may hit over 25% of employers starting in 2018

By Claire Thayer, September 2, 2015

One of the provisions of the Affordable Care Act is the high-cost plan tax (HCPT), aka the ‘Cadillac’ tax,  will be imposed on health insurance companies as well as sponsors of self-funded group health plans beginning in 2018.  Plans that exceed cost thresholds will incur the excise tax.  For 2018, cost thresholds are $10,200 for an individual (single coverage) and $27,500 for family. The excise tax is.............Click to continue

More About Us, Less About Them

By Kim Bellard, September 1, 2015

Something Amazon just did is worth those of us in health care paying attention to.  It was the layoff of "dozens" of engineers at Lab126, Amazon's hardware development center, as first reported by The Wall Street Journal.  These were the first layoffs in the division's history.............Click to continue

Independent Pharmacy Accountable Care Organizations

By William DeMarco, August 26, 2015

The competition for Pharmacy Services has become brutal as large chain stores such as Walgreens and CVS, as well as big box stores like Target and Walmart, attempt to develop exclusive service contracts with large insurance carriers and Pharmacy Management Companies (PBMs). At the same time.............Click to continue

The Role of Master Data Management in Health Care

By Claire Thayer, August 25, 2015

Health Market Science tells us that Master Data Management (MDM) in health care encompasses everything from patient data to provider data detailing the treatments, procedures, modalities, products and processes which govern and describe patient interactions and outcomes. A recent.............Click to continue

Seven Things to Know About Medicaid Going Forward

By Clive Riddle, August 20, 2015

  1. The most current CMS report indicates total Medicaid and CHIP enrollment of 71,637,638; with 509,082 additional people were enrolled during the past 30 days in the most recent reporting month (May 2015.)
  2. .............Click to continue

Examining ACO Makeup Evolution During Past Three Years

By Clive Riddle, August 14, 2015

Compiling Accountable Care Directory Data, we can look at how the makeup of ACOs around the country has evolved from since 2012. MCOL’s HealthQuest Publishers just released version 2 of its 2015 Accountable Care Directory, and has published updated directory twice a year since mid 2012. We’ve compiled data from the directories to provide a look at ACO composition over time.............Click to continue

Pharmaceutical Industry in Transition

By Clive Riddle, August 7, 2015

KPMG has just conducted a survey of pharmaceutical and medical device companies, finding “their biggest commercial challenges coming from payers, surpassing hurdles posed by regulators, declining access to healthcare providers, and the move toward specialty drugs.”

Based on these findings.............Click to continue

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



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MCOLBlog Team

Kim Bellard
KB Consulting
Columbus, OH

Krista Burris
Healthcare Strategy Consultant
San Francisco Bay Area


William DeMarco
DeMarco and Associates
Rockford, IL


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