Category Archive for "Healthcare"

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ACA Enrollment and Adverse Selection Pressures – An Update

Current health insurance exchange (HIE) enrollees skew older, to the extent that adverse selection pressures appear highly likely. Only 25% of enrollees are aged 18-34, as compared to the 40% enrollment share presumably needed for premiums and claims to balance

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Harvest Time for the Bill Collectors? The ACA’s Narrow Hospital Networks May Spur Demand for Revenue Cycle Management (RCM) Services

We compared hospital networks for plans sold on the health insurance exchanges (HIEs) to networks for plans sold (by the same issuer) off of the HIEs For the non-profit issuers and HUM the ‘on-HIE’ and ‘off-HIE’ networks appear the same;

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Your (HIE-based) Plan Doesn’t Cover That: A Comparison of Drug Formularies On and Off the Health Insurance Exchanges

For a podcast of this and other research notes, please see the SSR Health YouTube channel Popular brand drugs are much more likely to face restrictions in health plans sold on the Affordable Care Act’s (ACA’s) health insurance exchanges (HIEs),

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SSR Index of Current-Quarter Healthcare Demand Growth: Final 4Q13 Estimates and Thoughts on National Health Expenditure Data

Please see the SSR Health YouTube Channel for a detailed video walk-through of this research note We expect 3.5% (nominal) y/y growth in US health services demand during 4Q13, the product of 2.3% growth in demand intensity*, and 1.2% growth

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Adverse Selection on the HIEs – It’s Not (Just) About the Federal Website

Please see the SSR Health YouTube Channel for a detailed video walk-through of this research note Through December 28, enrollment in states operating their own health insurance exchanges (HIEs) is roughly 2x (in terms of the percent of potential beneficiaries

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Drug Benefit Chicken: An Analysis of Benefit Designs on the Health Insurance Exchanges

Please see the SSR Health YouTube Channel for a detailed video walk-through of this research note As compared to employer-sponsored insurance (ESI), health plans sold on the health insurance exchanges (HIEs): are (>3x) more likely to require that deductibles be

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MRK v. AMGN: A Comparison of R&D Productivity

Please see the SSR Health YouTube Channel for a detailed video walk-through of this research note In response to the Wall Street Journal report that MRK is planning a major shift in its R&D approach, we compare MRK’s R&D productivity

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Relative Price and Value of pre-Phase III Pipelines for the 22 Largest Drug & Biotech Companies

Please see the SSR Health YouTube Channel for a detailed video walk-through of this research note We believe pre-phase III (i.e. ‘hidden’) pipelines are misvalued for a very simple reason: they’re hidden. However because companies’ patenting behaviors are consistent and

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SSR Index of Current-Quarter Healthcare Demand Growth: Interim 4Q13 Estimates

We expect 3.5% (nominal) y/y growth in US health services demand during 4Q13, the product of 2.3% growth in unit demand, and 1.2% price growth. The 2.3% unit growth forecast would be a 30bp improvement over actual 3Q13 growth of 

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Why Adverse Selection is Likely on the HIEs: A Simple Model of Enrollment Behavior

We believe it is more likely than not that premiums paid by (or on behalf of) enrollees on the health insurance exchanges (HIEs) will be insufficient to cover both claims costs, and the operating costs of the health insurers participating

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