Reimbursement

Maryland's troubled insurance exchange is ending its contract with the lead IT developer and might be trying to recoup some of the millions that've been paid out, while calling in the nation's go-to HIX fix-it firm.

The healthcare industry has lagged behind retail, banking and other sectors in the adoption and use of data to improve efficiencies and services. Recently though, healthcare has seen increased interest in this approach as new payment models and reform initiatives require greater internal visibility and external transparency.

Aetna CEO Mark T. Bertolini believes that when times are tough, people want to hear the truth. In his Monday morning opening keynote here at HIMSS14, Bertolini was prepared to speak the unvarnished truth.

The recent delay of the employer mandate for medium-sized businesses will hurt not-for-profit hospitals because it postpones increased revenues from expanded coverage of previously uninsured patients, and the subsequent reduction in bad debt and charity care it would bring, a Moody's report said.

After watching the failures and successes of other states and HealthCare.gov, Idaho is making its own foray into running an insurance exchange, tapping a young Silicon Valley tech firm and an established Beltway contractor.

Since the recession first began in 2008, hospitals and health systems have continually seen a drop in inpatient volumes. Most industry experts say they expect more of the same for the rest of 2014 and even the next five years or so.

Medicare accountable care organizations are having varying rates of success in addressing their patients' diabetes and heart disease, according to government data released Friday.

In its third year as a Pioneer ACO, Montefiore Care Management has seen a 10 percent reduction in inpatient admissions, a 35 percent reduction in all-cause readmissions and a 45 percent reduction in diabetes inpatient admissions.

While keeping their options open, Medicare regulators are proposing to reduce Medicare Advantage rates by 3.5 percent, along with some other changes that could make the decline even steeper.

Massachusetts' new healthcare transparency agency is arguing that Partners HealthCare's acquisition of a suburban hospital is likely to raise employer and payer costs, setting the stage for state or federal authorities to block the deal.