Reimbursement

Just as government marketplaces are transforming their individual policy businesses, Blue Cross and Blue Shield companies are setting up private exchanges to save a far larger source of traditional revenue.

A quarter of the nation's hospitals in October will receive lower Medicare payments because their rates of patient complications are higher than their peers. Here is an explanation of the three measures Medicare is using to calculate the hospital-acquired conditions scores.

Many questions remain on how specific details of the Affordable Care Act will be resolved, but one significant trend is clear: the shift toward risk sharing among patients, providers and insurers is well underway.

Insurer premiums in the second year of public exchanges look financially wise to credit experts, although there are also some double-edged swords.

Even before federal approval is won for the experimental program, insurers in one large state are ready to start selling exchange plans to Medicaid beneficiaries.

After the botched rollout of insurance exchanges last year, the federal government is trying to get the technology right for what promises to be just as big a consumer turnout this fall.

A quarter of the nation's hospitals, those with the worst rates of hospital-acquired conditions, will lose 1 percent of every Medicare payment for a year starting in October. The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common.

A new start-up is hoping to become the largest enabler of primary care in the country within six years, by letting independent docs start ACO networks and stay free of the hassle of hospital systems and payers.

Aetna is extending its ACO network and health plan offerings in America's heartland, trying to meet promises of bringing accountable care to the commercially-insured masses in competition with United and WellPoint.

Any day now, the Supreme Court will issue its decision on the "contraception mandate" and could add more complexity to health plan administration, while another dispute may spell even more trouble.