Reimbursement

Many residents in New England are going to have more choices in the public exchanges this fall, as some insurers' growth strategies are tested.

States' taxing of Medicaid managed care organizations to raise revenue for state-share Medicaid payments may be illegal, according to the HHS Inspector General. If so, this raises serious questions that could shake up MCO financing models.

Hospitals in Georgia have struggled financially in recent years, as uncompensated care costs rose after the recession and the state rejected Medicaid expansion. But one standalone facility decided that affiliation and clinical integration might be the right path to stave off closure.

For employees, there can be nothing quite like the paperwork of HR and benefits, and for employers it can be expensive, especially with new ACA reporting requirements. Internet companies are trying to cash in on that, and could also shake up the insurance broker business.

For the first time in decades, cracks are appearing in the traditional fully insured model of healthcare coverage. The time is ripe for health systems to jump into the gap with an old approach delivered a new way -- direct contracting.

Amid new skepticism of back pain treatments, one of the largest medical device makers is being sued for a product that brought in close to one billion dollars annually at its peak while increasing risks for patients.

The practice of taxing Medicaid managed care organizations to raise revenue for state-share payments has left some auditors scratching their heads, raising questions that could shake up financing models.

Among all of the public money that federal healthcare watchdogs are trying to follow is a lot that will continue to be devoted to marketplaces and tax credits.

One third of Pennsylvania's hospitals had negative operating margins in the 2013 fiscal year, according to the Pennsylvania Healthcare Cost Containment Council, an independent state agency. The crisis is forcing health systems to rethink organizational mergers and management.

Around the country, narrow provider networks are sparking consumer backlashes, prompting regulatory intervention and also raising questions about the value of current insurance designs.