Reimbursement

California legislators are attempting to clear the way for undocumented immigrants to buy health insurance through the state's insurance exchange -- potentially setting a national precedent.

While losses in the Obamacare exchange markets are chasing insurance giant UnitedHealthcare away, New England insurer Harvard Pilgrim Health Care says the exchange business is a major moneymaker.

Current physician payment models are placing too much pressure on managers to convert quickly to value-based payment, a new report by the Alliance of Community Health Plans claims. Initiatives should more gradually impose risk models so that practices have time to make the needed investments.

Beginning in 2019, insurance companies that contract with the exchanges must either exclude from their networks any hospital that doesn't meet the federal government's 2020 target C-section rate or explain why they aren't, according to the new contract approved by the Covered California board.

Health insurance giant Aetna has declared victory in a years-old lawsuit against Bay Area Surgical Management, after a civil jury slapped the California medical group with a $37.4 million dollar judgement, Aetna said.

Hutchinson, a Republican, has backed continuing the policy with a few conservative tweaks he negotiated with the Obama administration.

Lowe's home improvement company, like a growing number of large companies nationwide, offers its employees an eye-catching benefit: certain major surgeries at prestigious hospitals at no cost to the employee.

Some people with cancer, HIV and multiple sclerosis have better access to high-cost specialty drugs in marketplace plans this year, yet a significant proportion of these plans still place many expensive drugs in cost-sharing categories that require the highest patient out-of-pocket costs, according to a new analysis.

In addition to payments, CMS is proposing new assessment-based quality measures, and claims-based measures for inclusion in the quality reporting program.

Bowing to pressure from the hospital industry and Congress, the Obama administration on Wednesday delayed releasing its new hospital quality rating measure just a day before its planned launch.