Author Archives: Joseph Burns

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Given that ‘step therapy’ is also called ‘fail first,’ there are many angles to pursue

Photo: ZaldyImg via Flickr

For journalists covering the Trump administration’s plan to expand step therapy to Medicare Advantage, there are important angles to cover now.

Under the rule issued by the federal Centers for Medicare and Medicaid Service, Medicare Advantage plans will now be able to use so-called step therapy when physicians prescribe drugs under Medicare Part B. Continue reading

Primary care physicians find value-based payments fail to cover their costs

It’s hard to imagine any physician starting an online fundraising effort to keep her practice open. But for Michelle Mitchell, M.D., a solo physician who runs Hawaii Family Health, the business model for primary care in her state is unsustainable otherwise.

She wants to raise $250,000 via a GoFundMe page that explains many of the financial problems she and her 15-member staff face running a practice that serves 2,500 patients in Hilo, the capital of the Big Island.   Continue reading

Amazon Berkshire’s health care initiative hires expert in contracting for quality

Dana Gelb Safran

Last spring, Atul Gawande, M.D., became chief executive officer of an unnamed initiative that will cover the health costs of 1.2 million employees and family members of Amazon, Berkshire Hathaway and J.P. Morgan. Shortly after being named CEO, Gawande said the initiative would aim to eliminate three kinds of waste in the health care system: administrative costs, high prices, and inappropriate use of health care services, as Zachary Tracer reported for Bloomberg News.

Last week, we got a clue about how Gawande might approach these three challenges when the initiative hired Dana Gelb Safran, Sc.D., from Blue Cross Blue Shield of Massachusetts. Continue reading

BCBS of Massachusetts will pay to keep patients out of the hospital

Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.

Blue Cross Blue Shield of Massachusetts announced this week that it is taking the radical step of paying to keep patients out of the hospital.

In a partnership with South Shore Health System in Weymouth, Mass., BCBSM will change the financial reward system so that it will tie payments to health system to its success in collaborating with physicians to improve quality, patient outcomes and costs for the patients they physicians and health system. Under BCBSM’s Alternative Quality Contract (AQC), the health insurer will reward the health system and physicians for their success in doing so, the two parties said in an Oct. 30 news release. Continue reading

Health care ballot measures challenge reporters to separate fact from fiction

Photo: Newslighter via Flickr 

In California, an initiative known as Proposition 8 asks voters to limit the revenue that kidney dialysis clinics can earn. The proposition pits health care unions against the large companies that run dialysis centers.

In Massachusetts, a ballot question asks voters to consider a proposal to limit how many patients a hospital can assign to each registered nurse at hospitals and other health care facilities. Continue reading

CVS-Aetna merger approval raises questions about competition and drug costs

Photo: afagen via Flickr

The merger of CVS Health, one of the nation’s largest pharmacy retailers, with third-largest health insurer Aetna has the potential to transform the health care system and raises concerns about the effect the merger could have on drug prices and competition. This would be the first time that a large pharmacy retailer gains control of one of the nation’s largest health insurers. CVS Health not only has 9,800 retail outlets in nearly every state (except Wyoming), but also 94 million members in pharmacy benefit manager CVS/Caremark. Continue reading