Reimbursement

For U.S. community health centers, the recent announcement of $295 million in Affordable Care Act funding was welcome news. But the five-year period of mandatory ACA funding expires next September, meaning CHCs face a reduction of up to 70 percent in grant funding.

With uncertainty in Medicare's accountable care program, some hospital systems are scrambling for long-term options and may give insurers a run for their money.

From incentivizing wellness to protecting against catastrophic loss, what's old is new again in health insurance advertising.

Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year.

California's lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the healthcare they are entitled to receive, according to a lawsuit filed Wednesday.

Call it managed care 2.0. The latest idea in affordable networks is bringing together a large insurer and disparate providers to create a simplified, integrated care system.

What happens when an insurer with the bulk of a state's public exchange membership pulls out?

The value-based model of healthcare is gradually transitioning from the pilot phase to implementation, as health insurers and providers strive to offer better care while eliminating unnecessary costs. But for providers who have always been paid fee-for-service, it is a different way of thinking.

Before the next open enrollment begins, verification issues are lingering for several hundred thousand consumers on existing exchange plans, leaving insurers and providers facing a range of potential problems.

Predictive analytics uses a variety of statistical techniques that analyze current and historical facts in order to make predictions about the future. In the healthcare setting, such data analysis can be effective in addressing a variety of key issues, including preventable readmissions.