Reimbursement

Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on.

As Montana's Blue Cross company evolves under a new corporate parent, state regulators are penalizing it for some alleged past misdeeds uncovered by an audit.

Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country.

With a banner of its logo draped over the New York Stock Exchange on the Friday before St. Patrick's Day, Castlight Health went public, in another sign that reducing friction and opacity in healthcare is sparking a gold rush of sorts.

Depending on the outcome of a lawsuit Cigna is pursuing in Los Angeles, more out-of-network providers may be able to offer patients discounts while billing health plans in full.

Studies and predictions around customer engagement and behavior trends focus on the empowered, online consumer. Forbes and Marketo cite that consumers expect super-personalized communications, consistent multi-channel interactions and sleek efficient tools. Payers are hit with delivering against these heightened expectations while responding to a host of new regulatory requirements. Luckily this double whammy has a silver lining; the technologies and tools that consumers demand can improve subscriber loyalty and the bottom line.

With researchers expecting a lot of fluctuating eligibility between Medicaid and exchange subsidies among lower-income consumers, states and insurers will have to devise new ways to solve the problem of continuity of care disruptions.

Hospitals are just beginning to catch on to the promise of integrated data analytics to manage patient population health and measure treatment outcomes. These benefits not only assist the transition toward patient-focused care, they're helping healthcare institutions reduce associated costs.

The drug formularies of some small group health plans in two states don't meet essential health benefit benchmarks, a new study has found, leaving researchers pointing to a solution that may be as complex as benefit mandates.

Federal healthcare auditors think Medicaid managed care organizations aren't doing enough to combat fraud and that states might have to step in with policy changes.