Reimbursement

A new Government Accountability Office report to the chairman of the Senate Finance Committee claims that federal rules may hinder states from applying to waive sections of the Affordable Care Act to make marketplace health insurance provisions more innovative.

Instead of buying a health insurance policy to cover their workers, a growing number of small and midsized companies are opting to pay their employees' medical claims directly, a potentially riskier practice financially called self-insuring, a recent study found.

Despite dire warnings from Republicans and some large insurers about the stability of the Affordable Care Act exchanges, an Obama administration report released Thursday indicated the individual health insurance market has steadily added healthier and lower-risk consumers.

In future rulemaking, the Centers for Medicare and Medicaid Services will propose that all issuers fund a small payment to the risk adjustment program to help marketplace insurers with high claims costs.

Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness.

Aetna has aligned with Duke Health and WakeMed Health & Hospitals in North Carolina on an expanded accountable care collaboration that will be open to larger, self-funded employers.

The Centers for Medicare and Medicaid Services has updated its five-star quality ratings for nursing homes that will likely alter the current ratings.

The cost to implement information technology needed to meet federal mandates for value-based care is taking a financial toll on physician-owned multispecialty practices, according to the Medical Group Management Association.

For the first time, most employers consider specialty pharmacy as the highest driver of healthcare costs.

Cloud-service platforms and software applications can help healthcare organizations of all sizes tackle big data issues.