Why People Support Utilization Management — Until It Affects Them
Most people support affordable housing in principle. Ask whether it should go on their block, and the answer often…
March 5, 2026
Most people support affordable housing in principle. Ask whether it should go on their block, and the answer often…
March 5, 2026
Imagine hiring a contractor to oversee a home renovation and paying him 20% of total project costs. If the…
February 17, 2026
The idiom “a needle in a haystack” refers to something extremely difficult to find. It implies that the needle…
February 4, 2026
When Arkansas banned PBMs from owning pharmacies, legislators cited a crisis: Independent pharmacies were closing at alarming rates. But…
January 20, 2026
When a jazz group improvises, the music works only because the players share an underlying framework. They agree on…
January 6, 2026
When rowers are aligned — matching their timing, rhythm, and pressure — the boat holds a steady line. Coordinated…
December 16, 2025
In international relations, hard power uses force or coercion — military action, sanctions, binding resolutions — to change another…
December 2, 2025
The phrase “grasping at straws” comes from a mid-16th century proverb, “a drowning man will clutch at a straw.”…
November 18, 2025
On September 3, 2025, during an announcement to end all state vaccine mandates — including long-standing school immunization requirements…
November 4, 2025
The ground is shifting beneath the U.S. vaccine landscape. For decades, the CDC’s adoption of ACIP recommendations has provided…
October 15, 2025
The United States faces a critical national security vulnerability: our dependence on China for the ingredients used to manufacture…
October 1, 2025
Direct-to-consumer (DTC) pharmacies promote convenience and transparent prices. But beneath the appealing marketing lies a more complex reality. Ten…
September 17, 2025
When asked if the pizza should be cut in six or eight slices, a customer said: “Six slices. I…
September 3, 2025
In baseball, the backstop — netting and a wall placed behind home plate — is designed to protect fans…
August 20, 2025
When policymakers think about what causes morbidity and mortality, heart and other chronic diseases, cancer, and accidents often come…
August 5, 2025
Netflix’s “Top 10 Today” shows what’s most watched — not what’s most worthwhile. A sensational reality show may outrank a…
July 16, 2025
There’s an old parable about a frog that’s placed in a pot of cool water that’s gradually heated. The…
July 1, 2025
The United States is falling behind. Since the mid-1980s, improvements in U.S. life expectancy have slowed compared with other…
June 17, 2025
Across industries, consumer priorities tend to emerge slowly. But once they take root, they change how we define value.…
June 4, 2025
History is replete with cautionary tales about the dangers of acting on insufficient evidence in pursuit of urgent goals.…
May 20, 2025
Just as many Americans seek affordable care abroad, the United States has been a leading destination for international patients…
May 6, 2025
Americans travel abroad for all kinds of reasons — vacation, business, education, family visits. Increasingly, they also travel for…
April 15, 2025
Why did the chicken cross the road? To get to the other side. This is an anti-joke where the…
April 1, 2025
Millions of people unknowingly rely on hidden security measures to protect them from unseen threats. At airports, the Transportation…
March 18, 2025
If you squeeze a balloon in one spot, the trapped air shifts and the balloon will expand where there…
March 6, 2025
Sometimes writers place quotation marks around a word or phrase to signal sarcasm, irony, disbelief, skepticism, disagreement, or belief…
February 18, 2025
Punching holes in things can be very useful. Evenly spaced holes made leather belts with metal buckles adjustable. Conductors…
February 4, 2025
Ever stood in front of a funhouse mirror? The warped reflections transform the way you look — stretching your…
January 14, 2025
Coinsurance is a percentage-based cost-sharing model where patients pay a portion of medical expenses after meeting their deductible. Unlike…
December 30, 2024
The modern proverb “people who live in glass houses shouldn’t throw stones” originated in 1385 when a primitive version…
December 9, 2024
In The Wizard of Oz, when Dorothy is ready to return home to Kansas, Glinda, the good witch, gives…
November 13, 2024
When sanding wood, different grits are used for different purposes: extra-coarse grits to smooth extra-rough and uneven surfaces and…
October 15, 2024
For millennia, people have looked at the heavens and tried to make sense of what they saw. Several moments…
September 18, 2024
There’s life and there’s death. It’s dichotomous… sort of. Dying is a process toward the end of life, and…
August 14, 2024
The idiom “to have an axe to grind” means to have a selfish reason or strong opinion that shapes…
July 17, 2024
You are what you eat. There is no denying the importance of good nutrition. A healthy diet can lower…
June 12, 2024
Sometimes we meet or even exceed our goals, and sometimes we fall short. For example, we might set out…
May 15, 2024
We’re constantly making predictions. Will it rain? How will they respond if we do or say X? How much…
April 9, 2024
We’re surrounded by countless currents carrying things from one location to another. Temperature gradients, concentration gradients, pressure gradients, electrical…
March 13, 2024
Why purge physical items when we can just rent additional storage space? Why delete digital files when we can…
February 14, 2024
If you’ve been in an old European castle with spiral stairs, then chances are the spiral stairs had a…
January 10, 2024
Do you remember watching Steven Spielberg’s 1975 movie Jaws? If so, you likely recall an early scene at a…
December 13, 2023
Smiling has been shown to boost mood; reduce blood pressure, pain, and stress; increase endurance; and strengthen the immune…
November 15, 2023
Let’s suppose you’re motivated to work on one of the several global challenges we face (God bless you). And…
October 12, 2023
Demand for products that combined “fen” (fenfluramine), an appetite depressant, with “phen” (phentermine), an amphetamine, soared after a small…
September 13, 2023
Most of us likely have heard the Verizon Wireless character say, “can you hear me now?” Those commercials ran…
August 16, 2023
As artificial intelligence (AI) permeates all facets of work and life, many thought leaders are increasingly concerned that AI…
July 12, 2023
Some find open conversations about sexual and reproductive health uncomfortable, yet many federal and state politicians comfortably and publicly…
June 14, 2023
A 1992 commercial starts with a young student coloring as the teacher drones on: “Stay within the lines, the…
May 18, 2023
“What’s in your backpack?” is a reference to the psychological load one carries. People with diabetes carry a heavy…
April 11, 2023
Travelers Insurance Co. has used an image of a red umbrella in its logo since 1870. It’s brilliant imagery…
March 15, 2023
Churning converts cream to butter. This process agitates the cream and separates it into butter and buttermilk. Whereas cream…
February 14, 2023
Whales sometimes beach themselves, but because of insufficient evidence, we don’t know why. There are several plausible explanations for…
January 17, 2023
Probability is the likelihood of something happening. When flipping a “fair” coin (i.e., one that has an equal chance…
December 14, 2022
Harvard Business School Professor of Leadership John Kotter says accelerating change often requires creating and sustaining a sense of…
November 16, 2022
Optical microscopes — sometimes called light microscopes — use a range of objective lenses to view small objects. Objective…
October 12, 2022
Picking a lock requires a couple tools, time and effort. In essence, pins are pushed out of the way…
September 14, 2022
There are rules, exceptions to rules, and rules for exceptions to rules. Yep, payers have all of the above,…
August 17, 2022
You’ve probably heard the phrase “raise the bar.” While its origin is based on the high jump and pole…
July 13, 2022
When you look in a mirror, who do you see? Not what, but who? How you see yourself may…
June 14, 2022
As far back as the 13th century, European craft guilds set and maintained standards for the quality of goods…
May 18, 2022
“Chop your own wood and it will warm you twice” is often attributed to Henry Ford, who had the…
April 13, 2022
War kills, injures, and sickens combatants and noncombatants, including innocent civilians. The horrors of war include burns, broken bones,…
March 16, 2022
For many people, selecting an ice cream flavor — even when there are many to choose from — is…
February 9, 2022
In his classic 1975 book titled Equality and Efficiency: The Big Tradeoff, economist Art Okun noted the tensions between…
January 12, 2022
Perhaps you’re familiar with — and sometimes can relate to — the Greek myth of Sisyphus, who is repeatedly…
December 15, 2021
Every year in the United States, diseases linked to smoking kill approximately 480,000 people, including more that 41,000 deaths…
November 10, 2021
Out with the old, in with the new. Gene therapies are ushering in a new age of treating and…
October 13, 2021
The three “wise monkeys” depicted in a 17th century wood carving at the Tosho-gu shrine in Nikko, Japan, represent…
September 15, 2021
The earth is warming — and it is warming faster. For the contiguous United States, the five warmest years…
August 11, 2021
Humpty Dumpty fell off a wall, and all the king’s horses and men couldn’t put him back together again.…
July 14, 2021
There are serious health conditions in which a new solution could fill a big unmet need. In that context,…
June 16, 2021
One might ask: How do I look in these jeans? That’s debatable. The fact that the prevalence of obesity…
May 12, 2021
If you watched TV during the ’70s, you likely saw various iterations of an ad that said, “When E.F…
April 14, 2021
The impressionist painter Claude Monet explored the effects of light on the color of objects. He often painted the…
March 17, 2021
Looking back, social scientists have seen the silver linings of the influenza epidemic of 1918, the cholera epidemic of…
February 10, 2021
3D printing, or additive manufacturing, creates three-dimensional objects from digital models by adding material, typically layer by layer. By…
January 14, 2021
Crystal balls have been associated with fortune telling for several hundred years. Today, actuaries do not use crystal balls…
December 16, 2020
The Statue of Liberty has welcomed generations of immigrants to the United States — its torch a symbol of…
November 18, 2020
Superheroes like Batman, Spiderman, Captain America, and Black Panther wear masks, and their brave acts reduce social costs. When…
October 15, 2020
The official motto of the United States of America can be found on our currency and coins: “In God…
September 16, 2020
Way back, surveyors chiseled marks in stone structures to serve as a “bench” for a leveling rod, ensuring consistent…
August 12, 2020
Everyone negatively impacted by gun violence hopes it is the shot heard around the world. Yet in the United…
July 15, 2020
Perhaps you’ve noticed that a standard deck of playing cards has 52 cards, just as there are 52 weeks…
June 18, 2020
Paint-by-number kits assign colors to specific areas to reproduce art, including great works like Leonardo da Vinci’s The Last…
May 13, 2020
In these dark and uncertain times, we seek light and predictability — even if that means a new normal.…
April 15, 2020
Someone once said something like, “When one door closes, another opens; but we often look so long and so…
March 11, 2020
Do you believe in love at first sight — like the instant head-over-heels connection between Cinderella and Prince Charming…
February 12, 2020
Sometimes you have to take a step back to see the big picture — the forest for the trees.…
January 16, 2020
During the holiday season when gifts are often exchanged, one might recall the old proverb: Don’t look a gift…
December 12, 2019
If you’ve experienced the joy of attending the Macy’s Thanksgiving Day Parade, you know that the balloons are huge.…
November 13, 2019
Life hacks are those simple, clever methods that boost productivity or efficiency. While the term life hack was coined…
October 15, 2019
Cherry Coke is sweet, but cherry picking a comparator to maximize the contrast effect can leave a sour taste…
September 19, 2019
Population health is on fire and, importantly, makes sense. And though the term is somewhat new (popularized by the…
August 14, 2019
A level playing field helps to ensure a fair contest between two teams — it wouldn’t be fair if…
July 10, 2019
Fads, crazes, hits, and styles come and go. Looking back, the popular diet, toy, song, or haircut now seems…
June 12, 2019
Why pay taxes? Likely to avoid the potential consequences of tax evasion. Why slow down after spotting a police…
May 15, 2019
Imagine a world without standards. There would be disagreements about everything. There would be no shared understanding of time…
April 10, 2019
You’re probably familiar with the mnemonic “I before E, except after C” which couples both a spelling rule and…
March 13, 2019
Many policymakers think there is a drug rebate crisis, and consultants who should know better have led them astray…
February 13, 2019
Sherpa guides have led explorers through the Himalayas for many years. In such challenging conditions, an effective guide is…
January 17, 2019
Winning a game of Monopoly — assuming players have the stamina to play to the end — depends on…
December 13, 2018
Invariably, you’ve questioned the fit of two or more things in countless situations — when working on a puzzle,…
November 14, 2018
The light bulb has become a symbol of innovation for good reason. Thomas Edison, the inventor and a cofounder…
October 16, 2018
Criticism of rebates between sellers and buyers is not new. For example, Standard Oil received rebates from railroads beginning…
September 12, 2018
There is growing scrutiny about the spend and trend of prescription drugs and the role PBMs play in it.…
August 15, 2018
Life and work are full of decisions — many small decisions and a few big decisions. One of the…
July 19, 2018
The near-monopolistic control the De Beers corporation exercises is the primary reason diamonds cost so much. Diamonds are not…
June 14, 2018
Benjamin Franklin said nothing in this world except death and taxes is certain. Of course, there are other some other…
May 17, 2018
You know the old saying, “An apple a day keeps the doctor away”? Or how about the idiom “An…
April 12, 2018
The Magilla Gorilla Show’s theme song chanted that “at any price, a gorilla like Magilla is mighty nice.” And MasterCard’s “Priceless”…
March 14, 2018
The spiritual “Dem Dry Bones” with catchy lines like “Hip bone connected to the back bone” provides an overly…
February 14, 2018
Organizations often make plans for the New Year, and reflections on the past year are typically part of this…
January 11, 2018
Perhaps you remember the “But wait! There’s more!” line from the Ginsu knife ads. Or maybe you recall anxiously…
December 14, 2017
Value-based contracts between payers and manufacturers are in vogue. From the payer’s perspective, paying for performance by getting reimbursed…
November 7, 2017
The Marshmallow Test — giving a young child a choice between eating one marshmallow now or getting two marshmallows…
October 12, 2017
Manufacturers can bring truly innovative drugs and medtech to market. But to health systems, it’s not just what manufacturers…
September 15, 2017
Some people dislike or even fear tight spaces, like crowded elevators. But for payers, there are several reasons to…
August 10, 2017
Off-label use of drugs and medical devices is legal and very common. Once a manufacturer has demonstrated to the…
July 12, 2017
Though all the king’s horses and all the king’s men couldn’t put Humpty Dumpty together again, it’s pretty easy…
June 15, 2017
Manufacturers and payers are guilty of making quick fixes that address a symptom but not the underlying problem. Sure,…
May 11, 2017
In the dance between manufacturers and payers, brands that initially achieve commercial success often become more successful. There is…
April 13, 2017
Cancer drugs: New products and uses and guidelines — oh my! Payers historically have avoided aggressive utilization management of…
March 16, 2017
Payers’ use of prior authorization (PA) is often discussed but seldom fully understood. Myths and misconceptions related to PAs…
February 9, 2017
Here’s a bumper sticker: Honk if you know what your customer really wants. For a manufacturer, successful payer marketing…
January 13, 2017
Measurement is commonly linked with good management. You may be familiar with the old saw in carpentry measure twice,…
December 15, 2016
Yes, sometimes payers view “non-inferior” products as being superior. Just how they react to new products with evidence of…
November 11, 2016
While P&T committee meetings are typically serious and professional, like all social situations, funny things can happen. Pharmacy and…
October 13, 2016
A mock pharmacy and therapeutics (P&T) or health technology assessment (HTA) committee meeting is one of several methods manufacturers…
September 15, 2016
An observer may ask whether a difference is significant. This seemingly simple question requires a nuanced answer, because there…
August 11, 2016
Convenience products are those that are relatively easier to use than alternatives already on the market. Products that require…
July 14, 2016
Change in health care is constant, and with that change payers expect new stuff — new products, services, evidence,…
June 16, 2016
Value. It is always wanted, commonly discussed, occasionally conceptualized, yet infrequently operationalized or measured correctly. But if optimizing value…
May 5, 2016
Payers often conduct a budget impact analysis to assess the affordability of a new offering, such as a drug,…
April 14, 2016
Real-World Decisions In essence, payers make formulary management/medical policy decisions based on three criteria: efficacy, safety and cost. When…
March 10, 2016
Are Payers Just Not That Into Your Brand? You’re trying to optimize market access for your brand, yet you…
February 12, 2016