Reimbursement

The Centers for Medicare & Medicaid Services issued a proposed rule Tuesday that would reduce Medicare payments to home health agencies by $58 million next year and hinted at changes to come.

A patient-centered medical home program with a physician-owned, multispecialty group has been so promising that Aetna is extending the arrangement.

Two years after upholding most of the Affordable Care Act, the U.S. Supreme Court has carved out a new religious exemption for employers, once again bringing women's health into the political fray and potentially adding new complications to group insurance.

The prospect of a near-duopoly healthcare market is becoming a reality, and only time will tell if two giant closed networks are good for both patients and business.

A regional patient-centered medical home demonstration is appears to be prime for expansion of Medicare members.

In an effort to survive and thrive in the transition to value-based payment models, New Jersey's Hackensack University Medical Center launched an experiment, which, so far, looks promising.

The Obama Administration wants to make it as easy as possible for the 8 million Americans who bought insurance via an exchange last year to keep their plans. To that end, the auto-enrollment policy Health and Human Services unwrapped aims to reduce complexity for insurers, but it also brings new issues.

Two large players in a small market are going to spend the next three years trying to collaborate with emerging incentives, as shared risk becomes the new normal.

The individual insurance market is now too big to ignore, drawing new crowds on and off state exchanges.

In this Golden Age of government programs, the health plan industry has never had more exposure to the generally poor performance of pharmacy benefit managers (PBMs). Performance metrics in Medicare, Medicaid and ObamaCare are directly tied to PBM execution, and the recent track record of these companies means they are the Achille's Heel of insurers.