Reimbursement

The country's largest state insurance exchange wants to be an active purchaser negotiating on behalf of consumer, and a data-driven convener of affordability and quality.

Speakers at the Healthcare Management Association 2015 Annual Institute warn providers to embrace models like capitation, accountable care and bundled payments.

Oregon's top health insurance regulator is taking the unusual step of encouraging higher premiums in a competitive individual market, where the lowest-cost plan may also be the most disruptive.

Taking a cue from Aetna, Ascension Health and companies beyond the healthcare industry, Tufts Health Plan is raising its minimum base wage.

Anthem is scrambling to save a $53 billion takeover of Cigna, while encountering some deep criticisms of its own future potential.

According to iVantage, these hospitals excel at managing risk, achieving high quality, outcomes and patient satisfaction while running on lower reimbursements and charges than their peers.

California health officials failed to ensure that more than 9 million residents enrolled in Medicaid managed care plans had access to doctors when they needed them, the state auditor said in a stinging report.

Fallon Health is departing from Massachusetts' Medicare-Medicaid managed care program, another sign that the sought-after benefits and savings will be hard to achieve.

A bipartisan group of House and Senate legislators introduced bills last week that would require health plans to cover the growing number of oral chemotherapy pills as favorably as they do intravenous chemotherapy.

While pent-up demand and new individual customers have contributed to higher-than-hoped-for premium increases, extraordinary claims have been less than feared, leaving some more money to spread around.