The Similarities Between Health Plans and Subscription Television

By Clive Riddle, January 13, 2017


One can even directly impact if people live or die.  The other merely informs and entertains. Still, as I recently turned on the television to discover my favorite local station currently wasn’t available because of a contract dispute with my satellite television service, it occurred to me that there are significant parallels between health plans and subscription channel services.


I must digress to say it isn’t that easy finding the correct, simple mainstream term to refer to all that is subscription cable television, satellite television, and streaming internet services. With devices now delivering an increasing load of channel viewing, should we even use the term “television“ when referring to subscription services?  Wikipedia provides the term Multichannel video programming distributor (MVPD), which doesn’t exactly roll of the tongue.


Both health plans and subscription channel services, by their very nature, are based upon the volume of subscribers they amass, the monthly subscription revenue they receive, and the network of providers they contract with (be they health care or channels.) Both are significantly regulated. Both are now dominated by mega companies that emerged from acquisitions. Both now try to distinct themselves by offering enhanced engagement through customer portals. Both are evolving and experiencing disruptive innovations and change. Both are experiencing their providers becoming integrated delivery systems (such as ESPN or HBO.)


And both are plagued by contract disputes with their provider networks.


Just this month, Hearst Television local channels were pulled from DirectTV over a contract dispute affecting markets across the country including Sacramento, Kansas City and Pittsburgh. DishTV experienced headlines including Dish loses more subscribers and says there’s no deal yet to bring back Fox, NFL, and Tribune Stations Blacked Out On Dish Network In 33 Markets.  Cable fare no better than satellite on this front. Comcast/Xfinity earlier this year had headline including As Opening Day looms, Comcast-YES flap leaves many Yankees fans shut out and Verizon headlines included Verizon Dumps The Weather Channel in Favor of Looking out the Window.


Does this sound familiar for health plan subscribers? Consider these recent headlines: Blue Cross to drop Texas Health Resources from its network in 2017 after contract dispute; Humana, Tenet Cut Ties over Contract Dispute; Blue Cross, Fairview network spat could affect 170k patients (Minnesota); or NMHS prepares to drop United as negotiations stall (Mississippi).


Is it any wonder that after much ado has been made for health plans investing in “narrow networks”, DISH TV has just introduced its “Skinny Bundle”?


The point is, it can be instructive for health stakeholders to consider the experiences and lessons learned in the subscription channel service arena, and vice-versa.


But one could argue that a significant dissimilarity between health plans and subscription channel services is that while the uninsured rate was cut in half during the past decade, the trend towards “cord cutting” for subscription channel services is growing, with 21.9% of households having been projected to be cable or satellite free by the end of 2016, while the overall U.S. uninsured rate has dipped below 9%. On the other hand, a material portion of these “cord cutters” have recently ventured into internet subscription services offered via Hulu and others that are still under the radar when cable and satellite subscriptions are counted, and for health plans – it remains to be seen what the percentage of uninsured will look like after “repeal and replace” occurs.


But still, it can be interesting to observe the portion of “cord cutters” cobbling together their own network of integrated providers, bypassing an overall subscription service: assembling their own customized collection of HBONow, ESPN, Netflix, Amazon and other channels. Is there a parallel to emerge for the inevitable increased number of post-repeal and replace uninsured?


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


U.S. House Republicans to vote on Obamacare repeal

Reuters reports: U.S. House Republicans moved ahead on Friday with legislation aimed at dismantling Obamacare, despite concerns about not having a replacement for the healthcare program and the potential financial cost of repealing President Barack Obama's landmark law.


Friday, January 13, 2017


Trump’s HHS Nominee Got A Sweetheart Deal From A Foreign Biotech Firm

Kaiser Health News reports: When tiny Australian biotech firm Innate Immunotherapeutics needed to raise money last summer, it didn’t issue stock on the open market. Instead, it offered a sweetheart deal to “sophisticated U.S. investors,” company documents show.

Kaiser Health News

Friday, January 13, 2017


CVS slashes price of substitute EpiPen auto-injectors to $109.99

Stat News reports: CVS Health announced Thursday morning that it has cut the price of two-packs of epinephrine auto-injectors to $109.99 — roughly the price that brand-name EpiPen shots were selling for eight years ago, before their escalating price became a hot political issue.

Stat News

Thursday, January 12, 2017


Sylvia Burwell urges need for Medicare to have drug price negotiating power

Healthcare Finance News reports: Giving Medicare authority to negotiate drug prices is the best way to keep those spiraling costs under control for the program's recipients, departing Health and Human Services Secretary Sylvia Burwell said Monday.

Healthcare Finance News

Tuesday, January 10, 2017


UnitedHealth Group to Buy Outpatient Surgery Chain for $2.3 Billion

The New York Times reports: UnitedHealth Group, one of the largest and most diversified health insurance companies in the United States, said on Monday that it planned to buy Surgical Care Affiliates, a chain of outpatient surgery centers, for about $2.3 billion. The deal is expected to close in the first half of 2017.

NY Times

Monday, January 9, 2017



These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Walgreens CEO: Obamacare Replacement Shouldn't Be To 'Detriment' Of U.S.

Forbes reports: Whatever the Republican Congress and Donald Trump's White House create to replace the Affordable Care Act, Walgreens Boots Alliance hopes it “will not be to the detriment of [U.S.] citizens,” the company’s top executive said Thursday.


Friday, January 6, 2017


Only 20 Percent Of Americans Support Health Law Repeal Without Replacement Plan

Kaiser Health News reports: The Republican strategy of repealing the Affordable Health Care Act before devising a replacement plan has the support of only one in five Americans, a poll released Friday finds.

Kaiser Health News

Friday, January 6, 2017


Medicare Failed To Recover Up To $125 Million In Overpayments, Records Show

Kaiser Health News reports: Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services.

Kaiser Health News

Friday, January 6, 2017


Ryan Says Obamacare Replacement Bill Will Be Done in 2017

Morning Consult reports: House Speaker Paul Ryan says legislative work on repealing and replacing the Affordable Care Act will be completed this year, but exactly when the transition takes place on insurance exchanges is still to be determined.

Morning Consult

Thursday, January 5, 2017


Commonwealth Fund study finds parallels in uninsured rate decline, other economic gains and ACA implementation

Healthcare Finance News reports: The vast majority of adults who enrolled for health insurance during the first open enrollment period would likely not have held coverage without the Affordable Care Act expansions, finds a new study from the Commonwealth Fund.

Healthcare Finance News

Thursday, January 5, 2017


These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 


Magnificent Seven Healthcare Business Trends for 2017

By Clive Riddle, January 3, 2017


Here’s seven trends, in no particular order, that we see weighing heavily on the business of healthcare during 2017. If they all come to pass, of course you should marvel at the wisdom and insight emanating from this blog. If they are well off the mark, well, here’s hoping for short memories and I’ll search for the delete button on this post.


1. Inaction on Several Fronts While Waiting For Other Shoe to Drop

The individual health insurance markets will be in a holding pattern pending the outcome of sorting through the weeds of the Repeal and Replace activities in Congress and the Trump administration. Ditto for Medicaid initiatives. CMS innovations could even end up in a holding pattern.


2. A new Trigger for Prescription Drug Pricing Backlash?

Furor over Mylan EpiPen pricing and other prescription drug cost stories have subsided a little, and it remains to be seen how and if the Trump administration and Congress weigh in on this. But if a new major prescription drug pricing story erupts, and the odds are sooner or later one will, it should trigger a new groundswell of support for some public response.


3. Year of the MACRA

MACRA was separate from the ACA and is somewhat insulated from ACA dismantling. While the framework for Medicare Quality Payment Program MIPS and APMs are already in place, 2017 will witness widespread activity as physicians follow through on positioning themselves.


4. Private Sector Embrace Also Keeps Value Based Care Momentum Strong

Even if ACA repeal goes so far as tearing asunder Medicare ACO initiatives and other public value based purchasing innovations, the private sector’s embrace of all things value based care will ensure an onward march in this direction.


5. Consumer Driven Care Gains New Momentum

The Trump Administration and new Congress policy agenda would seem to favor increased emphasis on all things consumer driven.


6. Aftermath of Health Plan Mega Mergers

The ACA was credited with helping set the stage for mega health plan mergers. It is difficult to imagine further mega merger activity in the current environment. Cigna and Anthem will surely unwind their deal.  Trump administration emphasis on deregulation might cause the DOJ to take the foot off the gas on their opposition to the Aetna-Humana deal, or at least be more prone to negotiation.


7. Impact of New Technology and Innovation

We may not know what the next New Big Thing is, but we should know that there will be one, and then another. And that one or more of these next new big things will have a major impact on the business of healthcare. 


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Medicare Penalizes Hospitals In Crackdown On Antibiotic-Resistant Infections

NPR reports: The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

Thursday, December 22, 2016


Cleveland Clinic CEO Toby Cosgrove named as contender for Trump's VA pick

Modern Healthcare reports: Cleveland Clinic CEO Dr. Toby Cosgrove was among prospective cabinet picks who met with President-elect Donald Trump on Tuesday. Cosgrove is reportedly a contender to lead the Veterans Affairs Department.

Modern Healthcare
Wednesday, December 21, 2016


Senate report shows Martin Shkreli is just as bad as you think he is

USA Today reports: Staggering hikes — in some cases higher than 5000%— in prices of prescription drugs threaten the health and economic stability of Americans who can't afford vital medicines, a congressional report warned Wednesday.

USA Today

Wednesday, December 21, 2016


Health Exchange Enrollment Jumps, Even as G.O.P. Pledges Repeal

The New York Times reports: About 6.4 million people have signed up for health insurance next year under the Affordable Care Act, the Obama administration said Wednesday, as people rushed to purchase plans regardless of Republican promises that the law will be repealed within months.

The New York Times
Wednesday, December 21, 2016


Women Doctors May Be Better For Patients’ Health

Kaiser Health News reports: When a patient goes to the best hospital, he or she usually hopes for a doctor who is knowledgeable and experienced. Something else to wish for? A woman physician.

Kaiser Health News
Monday, December 19, 2016



These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.