Reimbursement

Tapping into a Health Information Exchange to Manage the Healthcare Needs of a Complex Population

John Clark, population health program manager at UNC Health Care, said direct employer contracts that eliminate intermediaries and can really help a health system contain costs. But the approach comes with some risks.

Blue Cross Blue Shield of North Carolina is seeking $130 million from the government for payments owed for 2014, the insurer said.

As value-based reimbursement leads healthcare providers to dig deep for new technologies and create team structures to handle the switch, smaller providers are struggling to cover the costs.

WellCare Health Plans has completed its acquisition of Advicare Corp.'s Medicaid business, which includes the transfer of approximately 30,000 members to WellCare of South Carolina.

UnitedHealth Group Inc. is leaving California's insurance exchange at the end of this year, state officials confirmed Tuesday.

The use of advanced analytics by payers can improve administrative and medical costs, provider satisfaction and member health.

The Centers for Medicare and Medicaid is revising its policy to include shared savings ACOs in its upcoming Comprehensive Primary Care Plus program.

In Ohio, Coordinated Health Mutual is in receivership due to its extensive financial losses in the exchange market under its InHealth Mutual brand, according to Lt. Gov. Mary Taylor, who is also Ohio Director of Insurance.

The federal government is already pushing providers towards more risk, so it's not surprising that many are going all in by sponsoring a health plan.