Reimbursement

After more than a decade of legal turmoil, physicians in four states have won a concession from the nation's largest insurer to make getting paid less of a hassle, if not to get paid more.

Among the major changes proposed for Medicaid plans are new provider adequacy standards, new mandates for capitated rate setting, beneficiary protections in long-term care, forthcoming quality ratings, and an 85 percent medical cost administrative ratio.

The federal government has crafted the first regulatory change to Medicaid managed care in a decade, as more health plans take the challenge from states to cover growing Medicaid populations at a sustainable cost.

Health plans' current wellness initiatives and disease/case management programs may be leaving members who fall outside of the "very sick" and "healthy" categories unengaged.

New Hampshire ACO's goal is to have capitation make up 70 percent of reimbursements, dropping fee-for-service from its current 50 percent to 30 percent.

The move could affect 3,500 UPMC employees who are at least 60 years old and have 10 years on the job.

As California goes, so goes the country in capping consumer costs for medicines? That's what patient advocacy groups and and some pharmaceutical companies may be hoping.

A national for-profit giant and Michigan's largest health insurer are coming to a resolution over the long-standing, fractious trade issues of excluding and favoring.

A mix of old and new school insurers are the best health plans in the eyes of the 59,000 physicians and providers using the digital billing and record-keeping services of athenahealth.

Jay LaBine, MD, is a surgeon working at the forefront of America's changing healthcare economy, the provider-sponsored health plan.