Reimbursement

With a new study showing both inpatient reductions and specialty care increases linked to high-risk medical home patients, health systems have more evidence to buy into the PCMH model as part of their clinical and financial improvement strategies.

With a new study of Independence Blue Cross members, evidence on the effectiveness of the patient-centered medical home is swinging back towards the positive.

Aetna has won a huge state contract in Texas, pulling away 415,000 lives from Blue Cross Blue Shield and with them several billion dollars in revenue.

What's driving the highest per capita healthcare spending in the country? A half-decade's worth of government-funded research points to some contentious and perhaps uncomfortable trends.

Physicians groups want to preserve a key antitrust exemption for self-referrals under Medicare that the Obama Administration hopes to end for a number of costly services.

Health insurers can expect an increasing number of consumer education challenges around prescription drug management, as utilization controls are more prevalent in public exchange plans than in typical group insurance.

With open enrollment coming to a close, public insurance exchanges are starting to look like they won't be the money-loser many have been girding for, at least for WellPoint's health plans.

Amid problems ranging from the minor to the extreme, at least half a dozen state exchanges are offering enrollment extensions of sorts, but only one is pushing federal limits and trying to extend open enrollment.

Grab a photograph. Any photo. Then take it to a photocopier, and copy it. 

A central hypothesis underlying the case for health reform's insurance expansion is being challenged by new evidence, as the quest to reduce emergency visits and spending continues. The research also highlights ongoing concerns about primary care access.