Reimbursement

Already big and still growing, the U.S. healthcare system in 2015 will be scrutinized inside and out for signs of financial problems, the federal government's health investigator promises.

All HIPAA-covered health organizations, and especially insurers, have been handed a small victory in the war of administrative simplification, as federal regulators once again back off a policy change long in the making.

The CY 2015 final rule for the home health prospective payment system updates Medicare payment rates to home health agencies, and implements the second year of the four-year phase in of the rebasing of the payment system.

Embracing consumer-oriented healthcare, some providers are voluntarily adopting price transparency, while some insurers balk at proposed mandates to disclose their rates.

For now at least, the employer mandate isn't going anywhere. But small businesses are flocking to a new market, leaving behind traditional models.

Every organization looking at someone else's business thinks there is a tremendous amount of waste, and believes they could do it better if given the opportunity. This is just as true in healthcare as any other industry.

Many health insurers have spent close to a century operating under fee-for-service and are now changing course. Some new payers founded post-health reform, however, are trying to hit the value-based ground running.

Of all the things to try to build a better business for in healthcare, the nation's fourth-largest Blue Cross insurer is focusing on one of life's most crucial processes.

Insurance industry margins are only about 5 to 6 percent and it is a notoriously difficult business to run. Still, providers are increasingly moving into the insurance industry, and for some, it has been a good addition to their business model.

Encouraging employer programs for health and prevention with one hand, the federal government is trying with the other hand to stake out a limit to what can be required of employees. And it's getting a bit fractious in the wellness space.