Resources - Unlock Health

Resources

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

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

UnitedHealth Group – The “Death Star” of U.S. healthcare

If you have attended one of our speaking engagements or read any of our thought leadership, it might be easy to think we are a little obsessed with UnitedHealth Group. Truth is, we are a little obsessed. Every other health plan in the U.S. watches United and parrots its strategy in some way. So it’s not unreasonable to think that UnitedHealth Group is, in effect, the U.S. healthcare system. I could use 10-12 emails or blog posts to unpack United’s corporate strategy and its implications for the

So much Medicare Advantage noise, so little time

Medicare Advantage (MA) plans have emerged as a pivotal component of the U.S. healthcare system, with enrollment more than doubling since 2010. These plans offer seniors an alternative to traditional Medicare. For the first time last year, more than half (51 percent) of the 65 million eligible Medicare members opted for MA plans over traditional Medicare. By 2030, more than 60 percent of eligible members are projected to enroll in an MA plan.

Three things you need to know about Medicare Advantage today

Medicare Advantage is the fastest-growing health insurance product. Enrollment has more than doubled since 2010, but it is adding to the financial headwinds for hospitals and health systems and impacting overall financial sustainability, all while we continue to see increased pressures for payor consolidations.