Reimbursement

Under Hemingway Hall, HCSC's insurers added 3 million in membership, including in ACA exchanges, and the company tried to adapt and diversify, including adopting new information technology and preparing to contract in Medicaid.

Pat Hemingway Hall, one of the most successful female executives in the health insurance industry, is leaving behind a giant nonprofit company that is still evolving.

A few reasons why the want-to-be cholesterol blockbuster Praluent will not be as much of a "budget buster" as the medicine that cures most hepatitis C patients.

In addition to the payment change, CMS said it will begin penalizing skilled nursing facilities in 2018 that fail to report quality measures as part of the agency's shift towards value-based reimbursement.

Assurant is advancing plans to wind down its once-profitable health insurance business, though apparently has not found a buyer for it.

Like most mergers and acquisitions, the Aetna-Humana and Anthem-Cigna deals will need a fair amount of cultural alignment to yield the market complementaries and business synergies being promised amid the record-breaking valuations.

Assurant, one of the most profitable home and life insurers, is advancing its plans to leave the health insurance business and sell off a subsidiary in an attempt to cut its losses on the sector.

Picking the right insurance plans for your budget and health needs is challenging. Weighing monthly premiums and co-pays against yearly deductibles and comparing the benefits different plans offer can make your head spin, especially if you are newly insured.

Another ACA-funded co-op is going under, dissolving rather than confront an "unhealthy future." Many of the others are also struggling to stay in the black.

CMS recently released the long awaited risk adjustment filtering logic for the Medicare Advantage Encounter Data Processing System, requesting comment by August 21. This logic is an important factor in the future of risk adjustment.