Resources - Unlock Health

Resources

Unlock Health has deep experience in managed care consulting, revenue strategy, contract performance and negotiations, benchmarking, analytics, and strategic communications

New era of conflict with independent Blues?

Over the years, we’ve focused a lot of analysis on United Healthcare’s strategy and the impact on providers. Yet more recently, we’ve seen an increase in conflict between independent Blues and the physicians and hospitals that populate their networks. What’s going on here? First, most Blues are the dominant market share plans in their markets. We see Alabama and Mississippi with Blue market share north of 85%. States like Florida and North Carolina have Blues that have grown market share to

Debunking the RAND Study: How flawed data is hurting U.S. hospitals

For years hospitals and health systems have been the target of accusations of corporate greed and price gauging as a way to explain the high cost of healthcare. Newspapers, legislators, and researchers have claimed that some hospitals exploit their market share, charge multiples of Medicare, and make healthcare unaffordable for employers and consumers alike.

May you live in interesting times

Occasionally, we can recognize that we live in extraordinary and interesting times, and the current healthcare system is demonstrating qualities we have not seen in our lifetime. These extraordinary times should cause us to consider whether extraordinary changes are required to make this system work better.

Hospitals are damned if they do, damned if they don’t

Just before the recent Wall Street Journal (WSJ) series on healthcare costs, there was an article on May 9 titled “Hospitals are Refusing to Do Surgeries Unless You Pay in Full First.”  It reveals such an interesting dichotomy faced by healthcare providers. First, let’s define the problem. Hospitals face massive bad debt problems, and the dominant percentage is bad debt from commercially insured patients.  High deductibles and co-pays, onerous annual out of pocket maxes, and other tools used by

Prior authorizations should be renamed 'the Care Avoidance Process'

The last few years have seen a massive expansion of the use of care avoidance and payment avoidance policies by payors – denials, appeal denials, white bagging, brown bagging, and most expansively, prior authorizations (PA). The PA process may have been designed to help the process of accessing care, but it has morphed into something much bigger. In February 2023, researchers from the health policy think tank Kaiser Family Foundation (KFF)  estimated that there were 35 million prior authorizati

Is the nation’s largest payor becoming a closed system?

Anyone familiar with the U.S. healthcare system recognizes Kaiser Permanente (KP) as a closed system in certain geographies. In fact, KP is usually the top-rated health plan in its markets, and it demonstrates excellent patient satisfaction scores.  Now, we see the evolution of UnitedHealth Group into a closed system, with the ambition of dominating the country’s 75 largest metropolitan statistical areas (MSAs).  Notably, member satisfaction and patient satisfaction scores are more than a little

PBMs may represent everything wrong with U.S. healthcare

We don’t often find ourselves agreeing with Professor Ge Bai from Johns Hopkins, but she recently shared some information about pharmacy benefit managers (PBMs) that signals Congressional scrutiny should be unavoidable in the coming year or two. Bai told podcast host Stacey Richter that researchers at Johns Hopkins and the University of Utah looked at the 45 most commonly used generic medications taken by patients enrolled in a Medicare Part D pharmacy plan in 2021. They found that for every $1