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.

What Health Plans Should Know About Marketing Costs

By Claire Thayer, September 29, 2016

Getting your message in front of the right audience sounds easy enough, but can be quite complicated for health plans during open enrollment season as well as throughout the year for member outreach.  A recent study of administrative expenses for Blue Cross Blue Shield finds.............Click to continue

I Really Wish You Wouldn't Do That

By Kim Bellard, September 22, 2016

Digital rectal exams (DREs) typify much of what's wrong with our health care system.  Men dread going to go get them, and -- oh, by the way – they apparently don't actually provide much value. By the same token, routine pelvic exams for healthy women also don't have any proven value either.............Click to continue

Workplace family monthly health premiums rise to $1,512; deductibles up 12% in 2016

By Claire Thayer, September 15, 2016

In 2016, employer-sponsored health insurance covered half of the non-elderly population.  For the 18th year in a row,  the Kaiser Family Foundation & Health Research & Educational Trust (HRET) published findings from its annual survey of employers reflecting trends of employer sponsored health benefits on premiums, employee cost-sharing, wellness programs and employer opinions.............Click to continue

Uber, Lyft and Healthcare

By Clive Riddle, September 9, 2016

Bruce Japson, in his Forbes article earlier this summer - On-Demand Health's Growth Second Only To Uber And Lyft, that "investment in on-demand health services is projected to reach $1 billion in 2017 with Teladoc and rival telehealth firm American Well joining the likes of Uber and Lyft in the top 10 most funded on-demand companies, according to the most recent tally by consulting giant Accenture ACN -1.02%. Investment in on-demand health was just $200 million in 2014................Click to continue

High Drug Prices, Complexity of Drug Development and What the Market Will Bear

By Claire Thayer, August 30, 2016

The escalating cost of prescription drugs is of concern for all of us and impact stakeholders all across the health continuum: patients, payers, providers, as well as policy makers.   A recent Consumer Reports study, Is There a Cure for High Drug Prices?, offers these 5 reasons drug costs are ballooning.............Click to continue

EpiPens By The Numbers

by Clive Riddle, August 26, 2016

Without wading into the policy, prognostication, editorial or other narrative issues surrounding Mylan’s EpiPen pricing controversy, here simply is a collection of selected relevant data compiled related to all that is Mylan EpiPen:.............Click to continue

Out With the Old...Wait, Not in Health Care

By Kim Bellard, August 16, 2016

The last company still manufacturing VCRs announced it has ceased their production.  VCRs had a good run, most households had one, but their time has passed.  Meanwhile, the stethoscope is celebrating its 200th birthday, and is still virtually the universal symbol for health care professionals.  

There has got to be a moral in there somewhere.............Click to continue

Health Benefit Costs for Large Employers – Up 6% again in 2017

By Claire Thayer, August 12, 2016

This week, the National Business Group on Health released their Large Employers’ 2017 Health Plan Design Survey, with the ‘good’ news that the overall health benefit costs were only expected to increase.............Click to continue

A Snapshot of Managed Care Pie

By Clive Riddle, August 4, 2016

MCOL’s Managed Care Fact Sheet webpages are being updated to reflect current data, so I took this opportunity to grab some Facts and provide this preview, baking this snapshot of managed care pie.

National HMO Enrollment is 92.4 million for 2016, up from.............Click to continue

Common Culture – A source of strength for integrated delivery systems

By Cathy Eddy, July 25, 2016

On July 20, I had the opportunity to be part of a discussion that American Hospital Association and Sharp Healthcare hosted in San Diego for integrated delivery systems with health plans. I was asked to facilitate an exchange on key trends in product innovation.

During the day the discussion hit on many of the national trends we are seeing in our work with health plans around the country.............Click to continue

Connecting individuals to complex health care fraud schemes

By Claire Thayer, July 25, 2016

The U.S. Department of Justice has been busy in tracking down and convicting criminals in health care fraud related crimes.  This week, the U.S. Department of Justice announced its largest criminal healthcare fraud case against individuals in $1billion Medicare fraud scheme.............Click to continue

What Pokémon Go Means for Health Care

By Kim Bellard, July 21, 2016

In recent days there have been a flood of stories trying to explain the Pokémon Go craze.  
Many -- e.g., The New York Times and Fast Company -- believe that Pokémon Go is finally going to make augmented reality mainstream, as well as showing AR's advantages over virtual reality, since the latter typically.............Click to continue

Cost of a data breach in health care reaches $355

By Claire Thayer, July 19, 2016

The Ponemon Institute released a few new reports this summer on the cost of data breaches as well as ability of companies to adequately mitigate online incidents and cyber attacks. While the reports cross all major industries, noted below are a couple of important highlights pertaining to healthcare.............Click to continue

CMS Office of the Actuary on Health Expenditure Projections

By Clive Riddle, July 15, 2015

Where are US health care cost increases headed? The CMS Office of the Actuary tells us to expect 5.8 percent annual increases during 2015-2025, in their report.............Click to continue

Factors attributed to medication non-adherence

By Claire Thayer, July 12, 2016

Medication non-adherence has a huge impact on overall public health. Isolating factors attributed to nonadherence presents opportunities for providers and pharma organizations to not only step up to improve patient health outcomes, but also eliminaet.............Click to continue

How much of a game-changer is MACRA and the MIPS and APM paths?

By Clive Riddle, July 8, 2016

That is the question asked of panelists in the current edition of MCOL’s ThoughtLeaders. Here, in its entirety, is a response from one of the panel: Mark E. Lutes, Chair, Board of Directors / Member of the Firm, at Epstein Becker Green.  Actually, here’s the question posed in its entirety: “How much of a game-changer is MACRA and the MIPS and APM paths going to be for Medicare, and will Medicaid or Commercial programs adopt similar approaches for applicable segments?”

So here’s what Mark had to say in response.............Click to continue

When the Disruptor is the Disruptee

By Dennis Bolin, Health Plan Alliance, June 28, 2016

I don’t know about you but I am becoming tired of hearing about “disruption” in the health insurance industry. I hear and read the term everywhere and I wonder if it is overused. I just returned from this year’s AHIP Institute and I heard the term repeatedly in presentations and discussions. Whether the word used is.............Click to continue

Millennials Are (Not) So Different

By Kim Bellard, June 24, 2016

If we believe conventional wisdom about them, they like to live with their parents, at least until they can move into their urban-center condo.  They hate to drive.  They're maddening in the workplace, demanding lots of frills and constant praise yet returning little loyalty.  They're hyperconnected through their various digital devices.  And, when they deign to think about health care.............Click to continue

Two Thirds of Healthcare Stakeholders Have Faith in Consumers Using Online Tools to Engage With Their Doctor

By Clive Riddle, June 16, 2016

MCOL has conducted an e-poll, co-sponsored by Keenan, of healthcare business stakeholders regarding their opinion on consumer tools involved with healthcare costs or quality. Key questions were asked regarding consumer healthcare cost and quality tools; and ranking of applicable items with respect to overall effectiveness.............Click to continue

Insurance spending on behavioral health: Up for Mental Health / Down for Substance Use

By Claire Thayer, June 7, 2016

The June 2016 issue of Health Affairs takes a deep dive into behavioral health from several different vantage points, including public and private health spending, veteran’s mental health service use, quality measurement, mental illness and gun violence, drug monitoring, suicide prevention, along with.............Click to continue

IMS Institute on the Global Oncology Market

By Clive Riddle, June 2, 2016

The IMS Institute for Healthcare Informatics this week released their new study: Global Oncology Trend Report: A Review of 2015 and Outlook to 2020, which examines the current and future global oncology market. Their 42-page report tells us that “more than 20.............Click to continue

Blue Shield of California Releases Executive Pay Report

By Claire Thayer, May 31, 2016

This week, Blue Shield of California released its first report on executive pay, thanks in part to a state audit that raised questions on the amount of executive pay and large cash reserves, along with mounting public pressure to be.............Click to continue

Practicing in an Age of Uncertainty

By Kim Bellard, May 27, 2016

If you've ever had a hard time trying to decide what's best for your health, perhaps you can take comfort in the fact that physicians often aren't so sure either. 

Or perhaps not.

A new study in Annals of Surgery, and nicely reported on by Julia Belluz inVox, focused on surgical uncertainty. The researchers.............Click to continue

How are health plans meeting behavioral health needs of members?

By Claire Thayer, May 23, 2016

There’s been a lot of awareness about mental health lately, especially during the month of May – officially recognized as Mental Health Month, via Mental Health America .  In the spirit of this awareness, AHIP recently released a new 28-page issue brief on behavioral health benefits and mental health coverage from collective case studies of 11 member health plans. This new issue brief.............Click to continue

Patients Happy With PCPs But Not Always Following Their Advice Due to Costs

By Clive Riddle, May 19, 2016

The Physicians Foundation has just released a 74-page report with results from their Physicians Foundation Patient Survey conducted by Harris Poll. The report findings state that “95 percent of patients surveyed are satisfied or very satisfied with their PCP’s ability to explain information in a manner they understand, while 96 percent feel their physicians.............Click to continue

Walgreens raising awareness on mental health with online screening tools and telehealth services

By Claire Thayer, May 10, 2016

Walgreens and Mental Health America have forged an ambitious initiative to screen 3 million people for mental issue, by the end of 2017. Walgreens is well positioned to step up to expand mental health services and treatment options and has announced.............Click to continue

Hot Healthcare M&A Market Starting to Cool

By Clive Riddle, May 6, 2016

Irving Levin Associates reports that healthcare merger & acquisition activity, which has been relatively overheated, is starting to cool a little. Lisa E. Phillips, editor of Irving Levin’s Health Care M&A News tells us “the slowdown in deal volume in the first quarter of 2016 might simply be.............Click to continue

Getting on the Blockchain Bandwagon

By Kim Bellard, April 28, 2016

Face it: health care IT infrastructure is a mess.  After spending tens of billions of dollars to "incent" providers to move to EHRs, they're using them but are not very happy with them. We now have millions of electronic records that are still way too siloed, and all too often incomplete.

Enter blockchain.............Click to continue

Cyber attacks – a new reality for health care organizations

By Claire Thayer, April 20, 2016

The healthcare industry as a whole is at a critical juncture in its efforts to curb medical identity theft, data breaches and health care fraud. More than any other industry, health care is now leading the way for the highest number of records breached - 84.4 million alone in the first half of 2015. Hospitals, health plans, health systems and provider organizations are all doubling down on efforts to address.............Click to continue

Health Systems Advised to Tread Carefully When Considering Provider-led Health Plans

By Claire Thayer, April 18, 2016

McKinsey & Co released an in-depth paper that explores both growth and evolution of provider-led health plans and offers key questions health systems should think about when evaluating their current plans or considering offering stepping into to provider-led plan market space.............Click to continue

Ten Things to Know About The Comprehensive Primary Care Plus (CPC+) model

By Clive Riddle, April 15, 2016

1.  CPC+ is a CMS five-year initiative starting in January 2017 to create a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation.............Click to continue

52% of healthcare IT leaders evaluating cloud-based solutions for population health management

By Claire Thayer, April 12, 2016

A recent HIMSS Media survey of healthcare IT leaders identifies five key challenges in using connected health IT applications to support population health management.............Click to continue

Identity Crisis: The Need for Improved Healthcare Identity Management

by Clive Riddle, April 8, 2016

This week, Kathy Bardeen from LexisNexis spoke in a HealthcareWebSummit webinar on Mastering Identity Management in Healthcare.  The issue with that inaccurate and missing demographic information and inadequate authentication systems and processes threaten business integrity and success, financial outcomes, and member engagement. On top of that, there is the looming.............Click to continue

The Biosimilar Opportunity

By Clive Riddle, April 1, 2016

Biosimilars hold considerable future opportunity for helping address rapidly rising prescription costs. They also hold considerable opportunity for pharmaceutical companies seeking to offer them, as well as challenges for pharmaceutical holders of brand drugs that they would impact.............Click to continue

Aligning Wellness Program Incentives to Increase Use of Digital Health Apps

By Claire Thayer, March 29, 2016

A recent HealthMine survey of 500 insured consumers finds that half of those surveyed are enrolled in a wellness program and one-third received their health device/app as a benefit of their wellness program.  Of those now using digital health tools, most were.............Click to continue

Medication Adherence and Out of Pocket Costs

By Clive Riddle, March 25, 2016

While out of pocket costs impact consumer demand and utilization for healthcare services in various degrees for all aspects of care, the relationship is perhaps the most direct for prescriptions. This direct relationship is due to both the relatively lower average cost per prescription compared to the per unit cost of most other health care services, along with.............Click to continue

Under the Influence

By Kim Bellard, March 18, 2016

new analysis by ProPublica found that doctors who receive money from drug companies do, in fact, tend to prescribe more brand name drugs, and that the more money they got, the more brand name prescribing they did.

ProPublica looked at prescribing patterns.............Click to continue

Telemedicine and Virtual Visits preferred by close to one-third of consumers

By Claire Thayer, March 17, 2016

Telehealth, quite simply refers to the use of electronic technology to deliver health care and health information between patients and their providers. Use of mobile devices and smartphones for vitual visits and remote patient monitoring alone goes a long ways in terms of enhancing patient engagement. The American Telemedicine Association reports that up to.............Click to continue

HIMSS: Only 3% of Providers Believe Their Organization is Highly-Prepared for Transition to Value-Based Payment Model

By Claire Thayer, March 14, 2016

The clock is ticking! There’s a lot of incentive for hospitals and physicians to transition to value-based care.  With the onset of the Affordable Care Act, HHS has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016.............Click to continue

Retail Clinics: Trying to Reconcile Cost Per Visit, Utilization, Access and Convenience

By Clive Riddle, March 10, 2016

The March issue of Health Affairs features a paper presenting study findings on retail clinic:  Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending. The title would seem to say it all regarding their findings. The study involved retail clinic use by 3 million Aetna members, from 2010 to 2012 for 11 low-acuity conditions.............Click to continue

Truven Examines Scope and Drivers in Bundled Commercial Spend for Lower Joint Replacement

By Clive Riddle, March 4, 2016

Truven Health Analytics has just released a twelve page research brief:  Bundled Pricing for Total Joint Replacements in the Commercially Insured Population: Cost Variation Insights by Bundled Care Components, which follows up on their recently released eight page brief on this same topic: Geographic Variation and Cost-Driver Insights.............Click to continue

Use of Predictive Analytics in Health Care

By Claire Thayer, March 3, 2016

Healthcare payers and providers are increasingly looking for innovative strategies to leverage big data and use of predictive analytics across the organization to manage population health risks, identify claims trends, improve clinical outcomes, reduce costs, etc.  Management of all the data and integration of the systems built up over time is complex at best.............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