Reimbursement

After the first open enrollment period, WellPoint executives are confident that public exchanges will be profitable and that they won't be bailing anybody out. Other areas, they're not so sure about, despite better than expected first quarter results.

With at least 15 percent of Americans now covered through an accountable care organization of some sort, integration seems almost inexorable. But not all is well in the land of Medicare ACOs, and in the private sector, the evolution may hit a few dead ends.

A recent analysis of the federal government's 340B drug discount program suggests that eligibility is too broad and that lawmakers need to tighten it, which may mean that hundreds of hospitals currently in the program would be booted out.

Growing more anxious about the impact of the expensive new hepatitis C drug Sovaldi and the routes states may take, Medicaid managed care organizations are looking for help.

Hospitals are educating their staff and reworking their processes to comply with Medicare's two-midnight rule, which will likely reduce hospital revenue by shifting patients from inpatient to outpatient status.

How do consumers want to talk to their health plans? By any means possible, please, and right now.

Left as-is, current exchange formulary and network search technology has the potential for a lot of consumer dissatisfaction and backlash.

Cooperative health plans attracted more than 400,000 Americans during the first open enrollment period and, although their long-term viability is still not guaranteed, some are bullishly plotting to grab market share from incumbents next year.

Not-for-profit hospitals are facing huge revenue challenges amid payment reform and shifting payer mixes, leaving relationships with commercial insurers in a flux.

Many not-for-profit hospitals are still struggling to align revenue with capital deployment and expenses, a challenge that may grow as patients come in covered by exchange plans and Medicaid.