Reimbursement

The advent of population health presents challenges and opportunities to payers.

Humana may become the second major insurer to exit the exchange business in certain states, as it reported losses Wednesday stemming from that market.

Gallina succeeds Wayne S. DeVeydt, who, after more than a decade of service to Anthem, including 9 years in the executive vice president and chief financial officer role, decided to step down from the position effective May 31, citing family commitments and philanthropic work.

Insurers are picking up more of the cost of prescription pain drugs, according to a study linking that trend with the rise in opioid-related deaths.

Barred from restaurants, banned on airplanes and unwelcome in workplaces across America, smokers have become accustomed to hiding their habits. So it's no surprise many may now also be denying their habit when they buy health coverage from the federal health law's insurance exchanges.

ACO Partner takes on upfront costs of services and technology for physician practices, other providers to transform to value-based payments.

Proposed regulations released last week by the Centers for Medicare and Medicaid Services are raising concerns that the playing field is uneven, with 87 percent of solo practitioners getting penalized and 81 percent of clinicians in large groups earning bonuses, according to some estimates.

In the 2017 open enrollment period, the Centers for Medicare and Medicaid Services will pilot a program on Healthcare.gov to pair results of a 5-star care rating with health plans on the federal marketplace.

A surging interest in Medicare Advantage among the retirement-aged population and the fast-consolidating ranks of private payers has some experts asking whether the program might be the future of Medicare overall.

Florida Hospital has seen significant improvements in its case mix index, resulting in a $72.5 million increase in appropriate reimbursement since the implementation of a clinical documentation improvement program.