Reimbursement

The Centers for Medicare and Medicaid Service said the final revenue increase was driven by a spike in Medicare fee-for-service spending per capita estimates.

Moving beyond the 2014 "land grab," insurers in 2015 relied upon tried and true direct marketing approaches for member acquisition. Like the first open enrollment period, it seems for many, this was effective.

Hospitals see the proverbial writing on the wall, and are preparing for the industry transition to value-based purchasing. But under a value model, many organizations will struggle, at least initially, to maintain their margins and to retain adequate market share in their regions.

A 2008 federal law was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care. But until now, the government had only spelled out how the law applied to commercial plans.

For the third year, regulators have revamped reimbursement reductions into an average increase for Medicare plans serving America's growing senior populations, though not without requiring more work and oversight.

Issue raises concerns about how well the insurance marketplaces can handle the flux.

Horizon Blue Cross Blue Shield of New Jersey is on the trail of all things data, with a new executive position given a charge of making sense of it all, plus some other major comings and goings.

The likes of Lowe's and Walmart are moving ahead with the providers of excellence bundled payment model, applying it to a costly surgical treatment that's being marketed to an aging workforce with a low back pain epidemic.

One health system is getting on the wave of health transparency and posting price estimates, although it still comes with barriers to patients shopping around for health services.

Out of 1,010 large medical groups that Medicare evaluated under the physician value-based payment modifier, just 14 are getting payment increases this year. But at the same time, only 11 groups will be getting reductions for low quality or high spending.