Reimbursement

Medicare beneficiaries who live in urban areas may save money on their prescription drugs this year because they have better access to pharmacies in drug plan networks that charge lower copayments or coinsurance, according to the federal Centers for Medicare & Medicaid Services.

The state last week won federal approval to shift most of its Medicaid recipients into managed care organizations, which are paid a fixed monthly fee from the state for each person in the plan. It's a strategy employed by about three dozen states, many for decades, to provide more predictable spending.

For the first time, the Centers for Medicare and Medicaid Services and America's Health Insurance Plans have announced standard quality measures among payers, a move designed to reduce confusion and complexity for reporting providers.

A new report from the Center for Improving Value in Health Care reveals significant variation in payments in Colorado for hip and knee replacements between private health insurance payers and Medicare: Coloradans with private insurance in the northeast pay $55,000 more than their neighbors with Medicare, while those in Denver pay $17,000 over Medicare prices.

Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries reported a $1.2 billion decrease in profit year over year, according to their 2015 annual and fourth quarter financial results.

Health insurers who sold plans through the marketplaces in 2015, and who covered high cost individuals can expect to get $7.7 billion this year through the federal reinsurance program established under the Affordable Care Act, the Centers for Medicare and Medicaid Services announced Feb. 12.

Health insurers who sold plans through the marketplaces in 2015, and who covered high cost individuals can expect to get $7.7 billion this year through the federal reinsurance program established under the Affordable Care Act, the Centers for Medicare and Medicaid Services announced Feb. 12.

McKesson Health Solutions and Health QX on Wednesday announced an alliance designed to help insurers quickly design and scale complex bundled payment models.

In a recent study, Truven Health Analytics found more than a $10,000 price variation in bundled spending for knee and hip replacement, depending on geography.

Despite much hand-wringing over the size and quality of provider networks on the health insurance marketplaces, many top-notch hospitals are available in-network in marketplace plans this year, a new study found.