Reimbursement

The change from a fee-for-service healthcare model to a value-based approach might be inevitable, but that doesn't mean it's happening quickly. In fact, the majority of providers remain tied to the old model.

California's experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.

The proliferation and variety of accountable care designs in commercial insurance, Medicare Advantage and managed Medicaid highlight the need predict the appropriate cost of care, ensure access to needed services and raise quality. But how can value be measured?

Want to pay your health plan premiums while picking up medications, buying some batteries (or maybe a piece of chocolate) and getting a free cholesterol screening? Humana is betting that retail convenience will support its individual membership business.

A new payer-led patient information exchange in California is getting ready to hit the ground running.

Not only are employers prone to switching their health plans, but more are ending their group health benefits altogether, a sign of the growing importance of the individual market.

While population health models are wonderful, they have happened too sporadically. The healthcare payment system is not supporting this work and the U.S. needs a value-based system that accurately rewards population health models and initiatives.

Changing eligibility standards could purge a million or more beneficiaries from Medicaid rolls in California. A lawsuit seeks to stop the state from canceling coverage for Medi-Cal recipients who haven't been properly notified.

One of the greatest concerns among patient advocates, regulators and insurers alike is that buying and using a health plan may be too complex a task for some consumers. One state exchange is hoping it found a scalable solution.

Americans consume a staggering amount of the opioid painkiller hydrocodone, about 99 percent of the world's supply. In October, after 10 years of debate the Drug Enforcement Agency (DEA) reclassified medications like Vicodin, and products that combine hydrocodone with other drugs, as Schedule II controlled substances.