Reimbursement

Walmart's potential impact on healthcare is far greater than creating more primary care clinics or becoming just another health plan.

Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital, but the hospitals' efforts have set up a conflict with insurers.

Long heralded by technologists, telemedicine is increasingly in demand from consumers. But as insurers warm to reimbursing the service, challenges loom in attaining healthy return on investments.

In the new health insurance economy, where individual consumers have more and more choices, a health plan's brand is one of its biggest asset. Sometimes it has to be changed.

As more companies migrate to self-funding, insurers are trying to meet demand with better outsourced management and new stop loss products. But a few startups with radical ideas are trying to beat them, offering new services to capitalize on frustration with the status quo.

Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.

Lacking the expertise in-house and the time and money to seek outside help, many physicians have procrastinated on ICD-10 preparations. This an opportunity for both physicians and health plans to forge a collaborative relationship.

Of all the health organizations working as Medicaid managed care plans, a good number of provider-based plans are thriving, sometimes in places where traditional Medicaid HMOs are not.

Are we designing our population health management programs to serve the consumer in the year 2000 or today and beyond?

Along with the changes and new costs coming with health reform, past problems are cropping up for some insurers, even setting regulatory records.