Category Archives: Health plans

Should step therapy and prior authorization be outlawed?


In ‘Fail first’ fails patients in the Boston Sunday Globe, a patient with depression decries his health plan’s use of “step therapy,” which requires members to try less expensive drugs before switching to pricier products.  This is a brave article –the author is going public as a transgender man and as someone who suffers with depression– and I agree that he should not have to endure what he’s been going through. In his case the drug that worked for him was put onto the list of drugs requiring prior authorization. He had to spend endless time with the insurance company and get his doctor to advocate for him to keep him on his therapy.

The author would like to see insurance companies barred from using step therapy and prior authorization, “particularly when insurance companies are still turning profits on our premiums.” That’s a simple solution that will appeal to many readers. After all, the insurance company is standing in the way of what’s best and also inconveniencing the patient and doctor along the way. Yet this solution too simplistic and ignores the broader context in which this situation is unfolding.

As a society we’ve handed health insurers much of the responsibility for controlling costs, while also imposing a series of constraints on them that limit their scope of action. ObamaCare, which I support, takes this approach even further and puts the rest of the US in a similar position to where we are in Massachusetts.

In a more typical insurance business –like life insurance or liability insurance–  the insurance company succeeds by refusing to insure customers who are likely to file claims, increasing rates after claims are filed, and writing policies in such a way as to exclude most things that are likely to happen. There is regulation, but in general you’ll struggle to get life insurance if you’re about to die or if you flunk your medical exam, and your car insurance rates will rise if you get a speeding ticket or cause a crash. In many parts of the country, health insurance has worked like this as well.

But under RomneyCare and now ObamaCare, health plans can’t charge more for people with pre-existing conditions –such as depression– and can’t refuse to accept business even from customers who will definitely be unprofitable. Not only that, but even when insurers do a good job of controlling costs, their profits are capped due to minimum medical loss ratio regulations. If they don’t spend enough on medical costs then the excess premium is returned to the customer.

Before we place yet another restriction on cost containment methods for health plans, let’s look at the broader picture.

First, rising health care costs are a huge problem for employers, individuals and taxpayers. Have your raises been low for the last several years? It’s probably because your employer is paying more for health insurance instead of giving you a salary boost. Is your town having trouble balancing its budget and struggling to find funds to build new schools or hire teachers? A big driver is the rising cost of employee and retiree health care. So it’s really important to bring healthcare costs under control. Step therapy and prior authorization are reasonable ways to do it.

The price differences and impact on premiums are not trivial. The May 2014 issue of Consumer Reports compares prices of drugs before and after they go off patent. Two of the eight drugs on the list (Cymbalta and Abilify) are used for depression. One just went generic and the other will be generic next year. After three years off patent, Cymbalta is expected to cost $27 per month for the generic v. $538 for the brand, and Abilify $45 v. $900. In other words, these drugs will be 95% cheaper once the generic market kicks in. As someone paying insurance premiums, I would rather have someone use a product that costs 5% if it works just as well, including drugs that are generic right now.

Naturally, pharmaceutical companies will push newer, higher-priced products. That’s their job as profit-maximizing companies, and they have a wide array of marketing and sales tools available to them to make it happen. (Unlike health plans, pharmaceutical companies’ profits are not capped.) On the other side, the health plan needs a set of tools to deploy to keep things in balance. In today’s world of biologic drugs that cost tens or hundreds of thousands of dollars it’s prudent to expect most patients to step through a process of trying less expensive treatments first, especially when those treatments may work just as well or better and be less dangerous. If we want –as the author does– to have fully unrestricted access, then that would require some regulation of the price of drugs. Take that too far, however, and the incentive to develop new and innovative medicines will be compromised.

Step therapy and prior authorization are legitimate and even necessary tools. This doesn’t mean that these approaches shouldn’t be scrutinized. In particular, the author implies (although doesn’t come right out and say) that he went through a series of drugs before finding the one that worked for him. If that’s the case, then he shouldn’t be forced to go back and try ones that have already not worked for him. But it’s not clear that this is what’s happening.

Balancing cost, quality, access and convenience in today’s healthcare system is not easy. Making things better requires something more than legislating further restrictions on health insurers.
photo credit: torbakhopper via photopin cc

By healthcare consultant David E. Williams of the Health Business Group

Hooray for high-priced hepatitis treatment Sovaldi

Congratulations to Gilead Sciences for producing Sovaldi (sofosbuvir), which cures hepatitis C about 90 percent of the time. The drug has a list price tag of $84,000 for 12 weeks of treatment. That $1000 per pill price tag is causing concern among health insurers, policymakers and the general public. The Wall Street Journal (Sales Soar for Pricey Hepatitis Drug Sovaldi) emphasizes the negative impact the drug’s release is likely to have on health insurers’ profits this year.

Doctors and patients are rushing to embrace the drug, and prescribing has taken off during the first several months of availability. Despite the concerns about cost containment, health insurers and pharmacy benefit managers have done little to restrict access. Gilead is making money hand over fist.

This is the American healthcare system at its best: providing rich rewards to those who bring truly innovative solutions to market first and not letting cost concerns lead to rationing. I hope Gilead’s example spurs investors to fund other treatment breakthroughs and get them to market ahead of competitors. 

Hepatitis C is a scourge and the treatments have been difficult to take and not nearly as effective until now. One of the reasons the total costs of Sovaldi is so high is that there are millions of people who were infected years ago and are starting treatment now. The CDC recommends testing for baby boomers, many of who were unknowingly infected from intravenous drug use in the 60s and 70s or from a tainted transfusion received up till the early 1990s. Once the big group of long-term infected patients is tested and treated, and when more products like Sovaldi come to market, costs will decline.

The cost problem in American healthcare is not from products like Sovaldi that are expensive but work. The problem is expensive care that is less effective or even harmful.

I asked all nine candidates for Governor of Massachusetts the following question:

Hepatitis C is 3 or 4 times more common than HIV. New drugs that can cure the infection are coming on the market this year but they are very expensive. What role should the state play in ensuring that residents are tested, linked to care, and have access to these new medications?

Don Berwick, former head of CMS and the Institute for Healthcare Improvement, had a good answer:

“We have to recover money from ineffective care, wasteful care, and harmful care.  We need to work very hard to make sure that we have the resources liberated from health care waste, so we can rededicate them to things like proper hepatitis C care.”

None of the candidates had a great suggestion for how to make sure everyone gets tested. But the beauty of the profit motive is that Gilead is hard at work raising awareness about hepatitis C testing and treatment, which will benefit the company and patients.

By healthcare consultant David E. Williams of the Health Business Group

Health Business Group in HealthLeaders

HealthLeaders (‘Vicious Cycle’ Flagged in MA Hospital Financing Disparities) reports today on a white paper we contributed to about the impact of hospital price differences in Massachusetts.  We built on previously publicized price data to highlight the implications for middle class and lower income communities: they effectively subsidize their richer brethren who pay the same premiums but get their routine care from pricier providers.

One of the things that surprised us is that Medicaid managed care plans, which are hired by the state, pay teaching hospitals much more than they pay community hospitals.

The report includes four recommendations to address the disparities:

  1. Require high-cost providers to hold cost growth below the general benchmark under Chapter 224 of health reform
  2. Consider each provider’s payer mix when setting Medicaid (and possibly commercial) rates
  3. Implement a Medicaid Accountable Care Organization (ACO) to contain costs and encourage quality, rather than relying on cutting unit prices
  4. Encourage commercial health plans to design products that reward members who use low cost providers

I’m quoted in the article.

By healthcare consultant David E. Williams of the Health Business Group

15 minutes could save you… nothing in medical bills

Two medical bills arrived in the mail over the weekend. One requested $525 for a specialist office visit, another $250 for a routine colonoscopy at a hospital. Since I don’t think we owe for either of these and the numbers are pretty big I decided to tackle them.

The specialist bill was odd because it didn’t appear that the insurance company had been billed. We go to this specialist frequently and have had the same Blue Cross Blue Shield of MA plan for a long time so I wondered what happened. After going through the phone tree, being kept on hold and listening to a recording about “higher than normal call volume” I was connected with a customer service rep. She said, “actually looks like insurance just paid. Your balance is $5.” On the one hand I was happy but on the other hand if I had just waited for the next bill it sounds like I would not have had to call at all. I’m still not sure why they sent the bill to me without any indication of billing the insurance company.

For the colonoscopy I decided to call my health plan first to check whether I had full coverage. They had “higher than normal call volume,” too, which I think must be normal. They were surprised to hear about the request for $250 but then looked at the bill and said it had been submitted as an outpatient surgical procedure (for which I would owe $250) rather than as a routine preventive screening.

I then called the hospital and had a long wait on hold, although they didn’t say anything about it not being “normal” call volume. I explained the situation, the rep then went to do a bit of research and came back to tell me it was billed properly –but not as a routine colonoscopy– and could I please pay the $250. I said no, hung up the phone, and spoke to the patient who assured me it was in fact a routine, every 5 year screening.

Not exactly what to do next, I decided to send an email to the hospital (conveniently, there is a billing email on the bill) presenting the information I have. I was happy to receive a reply within one business day letting me know they were checking with the physician to look into it.

So bottom line: I spent about 45 minutes on these bills and don’t have a lot to show for my effort so far. On the other hand I have helped drive up administrative costs by prompting action from my specialist’s billing office, health plan customer service, hospital billing office and now a doctor.

By healthcare business consultant David E. Williams, President of the Health Business Group

Center for Health Care Innovation: Podcast interview with Independence Blue Cross

IBC Center for Health Care Innovation

IBC Center for Health Care Innovation

Independence Blue Cross (IBC) is opening a Center for Health Care Innovation with the intention of helping Philadelphia become the “Silicon Valley of Medical Science.” In this podcast interview, Terry Booker, VP of Corporate Development and Innovation at IBC discusses the new center, how it ties in to existing IBC innovation programs like the Dreamit accelerator, how it’s funded, and how success will be assessed.

Photo credit: Independence Blue Cross

By David E. Williams of the Health Business Group.

From “repeal and replace” to “retain and improve”

From repeal and replace to retain and improve

From repeal and replace to retain and improve

“Repeal and replace” has been the mantra of Affordable Care Act/ObamaCare opponents almost since ObamaCare.  Although the “repeal” part has been tried many times in the House, very little serious attention has been paid to the “replace” part. The recent proposal by Republican Senators Orrin Hatch, Tom Coburn and Richard Burr is still couched in “repeal and replace” terms, but the actual contents of The Patient Choice, Affordability, Responsibility, and Empowerment Act are best described as an effort to retain much of ObamaCare –including changes to Medicare, bans on insurance coverage caps, coverage for children up to age 26 and so on.

There are all sorts of things in this proposal that I don’t like, but in the interest of spurring constructive dialogue to actually improve the Affordable Care Act I will highlight a couple of provisions that I think are improvements.

The first one  is in Title 2, Section 201, which calls for allowing insurers to charge older people up to 5x what they charge younger people.

The second is Title 6, Section 601, which “caps the tax exclusion for employee’s health coverage at 65 percent of an average plan’s costs.” In other words, it limits the size of the tax deduction for employer-provided health insurance.

To reinforce my “retain and improve” label, keep in mind that both of these provisions are essentially tweaks to the ACA. The ACA limits insurers to charging 3x the premium for older v. younger people and the so-called “Cadillac Tax” also limits the deductibility of expensive plans.

In any case, here why I like these two provisions:

  • Older people already get a very good deal from the government. Medicare represents a significant transfer from the working age population to those who are older. While it’s true that people pay into Medicare while working, the amount they pay comes nowhere near the actual costs of the program. It’s a cruel irony that there are many taxpayers without health insurance who pay taxes that subsidize older people on Medicare. The Affordable Care Act exacerbates the transfer from young to old by effectively making younger people overpay for insurance and giving older people a subsidy. The Republican proposal improves intergenerational equity and also helps stabilize the insurance market by bringing the ratio into line with the actual difference in cost.
  • Providing a tax deduction for health insurance provides an incentive to spend more on health insurance and less on wages. It also represents an unfair advantage for those who get insurance through their work rather than on the individual market. I’m in favor of phasing out the deduction completely over time. This proposal from the GOP does a better job than ObamaCare of reducing the deduction

What do you think? Do you agree with the “retain and improve” label? Are there other things you like about the new proposal? Leave a comment on the blog or Twitter @HealthBizBlog

photo credit: katerkate via photopin cc

By David E. Williams of the Health Business Group

Health insurance exchange for employers: Interview with ConnectedHealth (transcript)

This is the transcript of my recent podcast interview with Joe Donlan, co-founder and president of ConnectedHealth.

Joe Donlan, co-founder and president of ConnectedHealth

Joe Donlan, co-founder and president of ConnectedHealth


David E. Williams: This is David Williams, president of the Health Business Group. I’m speaking today with Joe Donlan. He is president and co-founder of ConnectedHealth. Joe, thanks for joining me.

Joe Donlan: Glad to be here. Thanks, David.

Williams: Joe, what is ConnectedHealth? What’s the idea behind it?

Donlan: ConnectedHealth is a private health insurance exchange. We’re focused on helping employers grow their business by offering a compelling and competitive benefits package to help acquire and retain key talent. The idea is that by offering this type of defined contribution solution, we can get employees thinking about their health and financial security, thinking much more holistically about how they spend and allocate their benefit dollars across benefit options. We know that if an employee is healthy and financially secure, they tend to be more productive in the workplace and can focus on growing the business.

Williams: Joe, there are a number of private health insurance exchanges around. Some focus on specific areas. For example, some work more with retired employees, those that are Medicare-eligible. Does ConnectedHealth have a particular focus?

Donlan: Absolutely. Most of our focus has been on the commercial, under 65 market. We offer capabilities on a group basis as well as offering capabilities for individuals, while always going through the employer. We can help solve employer problems and provide competitive benefits packages both in an individual and group world to those employees.

A good example of what we’re seeing in the marketplace is employers that have both group-eligible populations as well as a lot of 1099 or part-time employees that might not be eligible for those group benefits but could benefit by having easy access to individual health insurance plans.

Our approach has been going to those employers and being able to solve for each and every single one of their employees, given their diverse employee population.

Williams: It’s interesting what you’re describing. From a health care policy perspective and with all the noise regarding the Affordable Care Act, you hear a lot about the employer mandate being a problem for employers. You’re coming at in the other way, which is to say an employer might want to offer benefits even to employees who wouldn’t typically be eligible, in order enhance their attractiveness as an employer.

Donlan: That’s exactly correct. The ACA and health reform really has accelerated much of our business. Our business was never predicated on health reform at all. It was predicated on the fact that employers still need competitive benefit solutions and given their size and challenges, those needs may vary. So, an employer that has fewer than 50 employees might have a different benefit strategy and approach than an employer that has 500 or 1000 employees. We try to solve for those different situations by leveraging our e-commerce shopping platform and oftentimes using a defined contribution approach in the process.

Williams: The idea of a shopping or a customer-oriented approach to selecting health insurance is a new one. It’s getting a lot of attention now because of the Affordable Care Act. But can you describe what the experience would be like for a user? And is it more like what they would do in a typical kind of insurance purchase or is it more similar to Amazon or some other kind of consumer e-commerce website?

Donlan: It’s a great question; Amazon often comes up in this type of discussion. And really, it’s pretty different from Amazon. When you go to Amazon, you tend to know what you want. You know what products you’re looking for and you’ve already done some research, and you go there and you type in that particular product and you buy it and take advantage of Prime and all the other great services that Amazon offers.

Our approach is that people in benefits don’t necessarily know what they want. I’ve been part of organizations that have been developing consumer-oriented health care decision support tools for the past 13 years. And so there have been a lot of lessons learned in terms of what works and what doesn’t work when presenting very difficult information or, said differently, providing solutions or answers to complicated health care questions. So we spend a lot of time thinking about behavioral economics and spend a lot of time thinking about how you establish frameworks and put decisions in context to make the decisions easier for the end user and consumer. We always start with the consumer in mind, and then work backwards in understanding the key factors that influence those decisions.

Health insurance and other related benefits are very complicated and can be very confusing. And when we start talking about an exchange or a marketplace environment, oftentimes we’re talking about creating more choice. But choice doesn’t necessarily ensure satisfaction. The approach we’ve taken is looking at the key factors and the influences: What are the attitudes? What are the behaviors that we can ask someone in order to provide a smart and intelligent recommendation about a particular product? And so, we ask things such as, what is your risk tolerance?

Certainly we don’t literally ask ‘What is your tolerance?’ We ask it in a way that helps people understand how they would balance their dollars so that they realize that if they pay less in premium they could end up spending a heck of a lot more money when they need care.

And that is a concept that, with the way we address the question and the graphics we use, makes it very intuitive for someone to understand. We also ask them how they typically use health care over the course of the year for themselves and their family members. We ask how many times they typically see a doctor and how many times they typically take prescriptions, et cetera. We then apply a proprietary algorithm to that data and information and, factor in their demographic information to all the different benefit plans that are available to them.

And we provide a recommendation from top to bottom depending upon how many choices they have. We don’t say, ‘Here’s your co-pay, co-insurance, deductible, premium.’ It’s ‘Here’s your premium, here’s how much we think you’re going to pay, an estimated out-of-pocket cost.’ So we provide premium plus cost of care, and then the maximum out-of-pocket cost; the total financial exposure.

The approach we’ve taken has been pretty been fascinating. We have been giving people peace of mind in their benefit decision because very simply, the way we display the benefit recommendations, they can see the total financial impact of their decision. They know their baseline of what they’re going to pay in premium and they know their worst-case scenario.

What people don’t typically know is that middle figure. We take the mystery out of it and present it in a way that the user can start to think about what trade-off they may want to make. So if they spend a little bit more money in premium, they can see what the total impact might be and the decrease in estimated out-of-pocket cost or total maximum out-of-pocket cost.

Williams: So, when people think about shopping on these exchanges or marketplaces, there are many barriers, especially for those who don’t make their living like you and I do, thinking about this sort of thing every day. You just went through co-pay, co-insurance deductible, premium. But of course there are other sorts of things to consider – PPO, HMO, POS, narrow networks – all sorts of things that someone may have to deal with. And even the just the notion of it, is it a marketplace or an exchange, it’s pretty hard.

I don’t want to put words in your mouth but to get to the point of making the sort of trade-offs that you’re describing, does the user have to understand all that terminology?

Donlan: They really don’t. Since we keep this focused on essentially the financials, they see what the impact is on those three levers – the premium, estimated out-of-pocket cost and maximum out-of-pocket cost. We provide filters and using sliders, just as someone might use when they’re shopping for an airline ticket at You can very easily start to understand what the impact might be of your risk. So you have your ability and your tolerance for risk.

It’s very easy to say that, ok, if I’m willing to pay a little bit more every month, what might the decrease in cost be and how might it change the total financial exposure? These are the things that keep the stories off of the New York Times and the Wall Street Journal. We avoid a situation where a family chooses a plan without realizing that the maximum out-of-pocket was $30,000 and then, all of a sudden, they’re bankrupt. We are very clear and upfront about what that total cost is for the health plans so there’s level of transparency. What we’re finding with our clients is that it has given people a lot of peace of mind in order to buy.

We’ve seen with one of our grow their business based on number of applications submitted by over 130 percent. At the same time, they decreased their call center calls by nearly 40 percent. That tells us that people are coming to the shopping platform, they’re navigating it in a way that they would with any contemporary shopping/e-commerce site, and they’re transacting and making the purchase.

We’re seeing a lot of really positive results by taking this approach; it took us a long time to get here. We are applying the lessons that we have acquired over these 10-plus years; understanding the decision points and understanding the complexities of these decisions and figuring out how to make it simple.

On the backend, the way I like to describe it is it’s kind of like an iPhone. The shopping platform is very easy to use, very easy. All the magic essentially happens behind the scenes. We do the hard work behind the scenes so that the user can have a more enjoyable and seamless experience when they’re navigating the site.

Williams: I know you’ve been at this for quite awhile. But for most people, they’re just getting exposure to the kind of shopping experience that you’re describing. I’d like you to push fast forward and think about where we get to in five years. Once it’s kind of routine to use this sort of platform, what kind of extensions might there be on it? What’s next for an employer, beyond trying to get people to buy and use the platform? Where does it go from here?

Donlan: I think we’re just scratching the surface right now, David. And what’s going to be really fun to watch in the market is how levels of personalization continue to get enhanced just like you’ve seen in many other industries. So we spend a lot of time looking at the financial services industry as an example, and think that there are a lot of parallels into what we’re doing in the benefits world.

So the concept of someone thinking about their overall benefits portfolio and how an individual may want to allocate dollars across that benefits portfolio from a health and financial protection standpoint is pretty exciting to me. And in order to make that successful, data and information are going to be key to drive personalization. You can envision a world just as if someone was sitting down with their financial advisor and they’re saying that they want to have a child and they want to retire in 40 years and they want to have a house in Florida when they retire, etcetera. And that financial adviser answers, “OK, here’s what your portfolio needs to look like.”

But that portfolio may change once you have children and maybe multiple children. Maybe you choose to send one of your children to a private school instead of public school. I think the same will hold true when someone looks at this holistic benefits portfolio and how they allocate dollars. Having a child is a good example. You may adjust your benefits portfolio and start allocating more dollars towards life insurance than you would have when you didn’t have children.

So, that’s where the really exciting times are ahead of us is. It’s getting people to take ownership of their health and financial security portfolio.

Williams: I’ve been speaking today with Joe Donlan, president and co-founder of ConnectedHealth. We’ve been talking about private health insurance exchanges. Joe, thanks so much for your time.

Donlan: Thank you, David. I really appreciate talking to you today.

Wall Street Journal shames itself with health policy coverage

The Wall Street Journal’s Op/Ed page has always been very conservative, but traditionally the news sections have been balanced and objective. When Rupert Murdoch took over the Journal a few years back, an Australian friend warned me that objectivity in the new section would soon be out the window. Overall I have been fairly happy with the Journal under Murdoch’s ownership. Obviously it would have been unrealistic to expect everything to stay the same; Murdoch’s team has done a good job of adding new features even if some of them are a little fluffy.

But in recent months I’ve noticed that the Journal is going out of its way to undermine the Affordable Care Act on the news pages. Sometimes it’s by slanting real news stories negatively. Other times –like today’s front page article Patients Cram In Tests Before Health-Law Start, it’s by making up news out of nowhere.

Here’s the lead:

Thousands of people are cramming in tests, elective procedures and specialist visits before year’s end, seeking out top research hospitals and physician groups that will be left out of some 2014 insurance plans under the new health law, health-care providers say.

Many insurers offering plans under the law are slimming down their networks of doctors and hospitals in a bid to lower the cost of policies, which begin coverage Wednesday.

The article continues with a discussion of how more of the plans being sold on exchanges feature narrow networks and often exclude high-priced academic medical centers. The story includes a few anecdotes supplied by high-priced hospitals about patients deciding to get surgery or a colonoscopy this year instead of next, but there’s no data presented to back up the assertions.

The implication is that patients are rushing to use their “good” health insurance before Obama takes it away. But this really doesn’t make a lot of sense. Reading between the lines –or more literally the first word “thousands”– I don’t think the editor actually believes this is a real story either.

Think about it. There are more than 300 million people in this country. It’s front-page news that “thousands” are supposedly getting care a little sooner than planned? In addition, the logical chain is pretty weak. Every year people rush to use up their benefits or just push to get things done around the end of the year when they have time off of work. Many of the people getting coverage on the exchanges are newly insured –so their access is increasing, not narrowing. Even those who are getting narrower networks are likely saving significant dollars on their premiums. And isn’t it actually a good thing that the Affordable Care Act is increasing competitive pressures on high-priced providers, who now must do more to show that they are actually better or be forced to bring their pricing into line?

It’s sad to see the Journal fall to this level.

By David E. Williams of the Health Business Group.

Ali Velshi interviews me about the ObamaCare rollout

I was interviewed last night on Real Money with Ali Velshi, which airs on Al Jazeera America. We touched on what’s going wrong and what’s going right on the federal and state health insurance exchanges. Click on the video below to see me answer the first question.


By David E. Williams of the Health Business Group.

Health insurance exchange for employers: Interview with ConnectedHealth

Joe Donlan, co-founder and president of ConnectedHealth

Joe Donlan, co-founder and president of ConnectedHealth

With all the fighting over ObamaCare and the botched launch of the federal exchange, it’s easy to lose track of the fact that online insurance marketplaces are an efficient and effective way to compare and select coverage. Exchanges are catching on in the private sector and I expect their growth rate to increase as people get used to them.

ConnectedHealth provides an exchange platform for active employees (as opposed to retirees). They focus on helping employees understand what’s available to them and the full financial consequences of their decisions. Their platform is designed to serve companies who may have a mix of employees: group eligible (i.e., full time, permanent workers), part-time employees, and 1099 independent contractors. Employers are offering the platform in order to attract and retain employees and to help those employees make the most of their benefits and avoid surprises.

In this podcast interview, ConnectedHealth co-founder and president, Joe Donlan explains how it works.


By David E. Williams of the Health Business Group.