Reimbursement

For the many health organizations trying out or diving into accountable care, there are some important ideas from abroad to consider during the next stages of design and evaluation.

It's been pretty quiet lately on the Obamcare front, but that is about to change. To say this fall's open-enrollment has the potential to be problematic is an understatement.

Healthcare advocates for seniors are trying to stop a managed care expansion for the country's largest Medicare-Medicaid dual eligible population, in what could be a precedent for other states.

Americans living in rural areas will be a key target as insurers, states and nonprofit groups strategize how to enroll more people in exchange plans this fall.

The currents of health reform and consumerization are getting more treacherous for incumbent hospital businesses, but payers and retailers, especially, have waves to ride.

Aetna's ACO portfolio keeps growing, as the insurer tries to capitalize on Medicare Advantage rate pressure and step in where some competitors face upheaval.

Inpatient rehabilitation services are already a big target area for recovery audit contractors, and there will likely be more denials as audits ramp back up. Providers must remain consistent, proactive and vigilant to protect their revenue.

Medicare plans are mid-way through the process of creating Annual Election Period (AEP) materials that are due to members by the end of September. At this stage of the game, tension is running high and time is running out.

Many insurers setting premiums for the upcoming exchange season seem to be banking on consumer price sensitivity. Some are also poised to draw the most cost-conscious enrollees away from competitors.

Accountable care organizations are captivating because they contain elements of care delivery that most experts agree should improve healthcare: financial risk sharing, electronic health records, quality benchmarks, patient engagement and care coordination. But the question remains: can ACOs pull it off?