Reimbursement
A health plan and a health system are preparing for the rise of capitation in Medicaid with a new care management venture, as more state programs try to phase out fee-for-service.
How do hospitals survive if they keep patients healthy and at home? For New Hampshire’s New London Hospital, the answer is to partner with the largest hospital in the state to keep costs low and possibly boost patient volume.
Pressure is growing on insurers to stop using mail-order pharmacies for speciality medications, and also on benefits managers to find new ways to get lower drug prices.
Even amid delays in enforcement of the Affordable Care Act's employer mandate, tax and reporting regulations are sowing confusion among employers and putting large businesses on edge.
Two accountable care networks spanning three health systems have landed contracts with one of the country's largest private employers, in a model that could leave traditional players behind.
One of the worst failures of the Affordable Care Act is that, even with subsidies, the premiums and out-of-pocket expenses are unaffordable for far too many people. Unfortunately, a new proposal for catastrophic plans with very high deductibles would make accessing healthcare truly unaffordable for even more people.
Hospital revenue fell in 2014's first quarter compared with the final three months of 2013, the Census Bureau estimated last week. And for a full year -- from Q1 2013 to Q1 2014 -- revenue for healthcare and social assistance rose only 2.9 percent.
"Clinical integration" and "organizing for value" are two key themes at the HFMA 2014 ANI conference. Both are crucial in preparation for the transition from a fee-for-service reimbursement system. Here's an example of how one health system is preparing, by teaming with a health plan on a new care management venture.
In the midst of the exchange evolution, insurers are taking some common but also some diverging paths when it comes to the private HIXs transforming the group market.
The Affordable Care Act requires employers to provide coverage for full-time employees, but not part-timers. That sounds like a straightforward and reasonable provision, but as usual the devil is in the details.