Reimbursement

In the debate over provider networks, broad access has been the goal of many patient advocates, but some are also warning of unintended consequences of over-regulation.

The Affordable Care Act is boosting short-term finances for insurers and providers alike. Long-term, though, traditional business models appear untenable and health organizations must evolve to remain sustainable.

A once-promised truth in pharmaceutical benefits management is unravelling, leaving payers exposed and researchers scratching their heads.

Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital, but the hospitals' efforts have set up a conflict with insurers.

Long heralded by technologists, telemedicine is increasingly in demand from consumers. But as insurers warm to reimbursing the service, challenges loom in attaining healthy return on investments.

In the new health insurance economy, where individual consumers have more and more choices, a health plan's brand is one of its biggest asset. Sometimes it has to be changed.

As more companies migrate to self-funding, insurers are trying to meet demand with better outsourced management and new stop loss products. But a few startups with radical ideas are trying to beat them, offering new services to capitalize on frustration with the status quo.

Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.

Of all the health organizations working as Medicaid managed care plans, a good number of provider-based plans are thriving, sometimes in places where traditional Medicaid HMOs are not.

Along with the changes and new costs coming with health reform, past problems are cropping up for some insurers, even setting regulatory records.