Reimbursement

Aetna is again showing that the new insurance market, along with the business of health reform, can be profitable.

The plan claims to give employers the potential to save up to 15 percent over Aetna's traditional broad provider network plans.

Baptist made money doing what used to be industry heresy: reducing patients' use of the medical system.

Qualitest survey found 28 percent of organizations said they have done any revenue impact testing with payers.

For sale: Historic health insurance company with one million customers, $2 billion in revenue, some recent losses and mixed customer satisfaction, plus a modestly profitable voluntary benefits unit.

For both insurers seeking value and health systems pursuing all things integration, there is a huge conundrum waiting for an intervention: the hospital facility fee.

Doctors have called the programs confusing and time-consuming and say they offer little clinical benefit while detracting from their ability to care for patients.

"We're comfortable being known as the health plan that wants to put health systems in the business of selling insurance."

Lynda Douglas thought she had a deal with Tennessee. She would adopt and love a tiny, unwanted, profoundly disabled girl named Charla. The private insurance companies that run Tennessee's Medicaid program would cover Charla's healthcare.

The insurer is demanding reductions from what it believes are overpaid hospitals and physicians, while CHI is health is trying to meet it with what it believes are reasonable compromises.