Reimbursement
Provider network controversies from the first Affordable Care Act enrollment are coming back to bite two large Blues in the second open enrollment, while raising questions about responsibility for consumer confusion.
Accountable care organizations can be risky business. ACO care partners must be able to depend on one another for proper patient handling, data flow, clinical cooperation, revenue sharing and other agreed-upon measures.
The change from a fee-for-service healthcare model to a value-based approach might be inevitable, but that doesn't mean it's happening quickly. In fact, the majority of providers remain tied to the old model.
California's experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.
Want to pay your health plan premiums while picking up medications, buying some batteries (or maybe a piece of chocolate) and getting a free cholesterol screening? Humana is betting that retail convenience will support its individual membership business.
A new payer-led patient information exchange in California is getting ready to hit the ground running.
Not only are employers prone to switching their health plans, but more are ending their group health benefits altogether, a sign of the growing importance of the individual market.
Changing eligibility standards could purge a million or more beneficiaries from Medicaid rolls in California. A lawsuit seeks to stop the state from canceling coverage for Medi-Cal recipients who haven't been properly notified.
One of the greatest concerns among patient advocates, regulators and insurers alike is that buying and using a health plan may be too complex a task for some consumers. One state exchange is hoping it found a scalable solution.
Americans working to improve their eating and activity habits often fail, and not for lack of investment by employers, insurers and wellness vendors. Despite, or perhaps because of those challenges, Cigna is taking another crack at the problem.