Reimbursement
Horizon Blue Cross Blue Shield of New Jersey has launched the state's first patient-centered pregnancy and delivery episode of care program designed to bring about better outcomes, patient experience and lower costs through better coordination of care for pregnant women.
UnitedHealth Group may be acquiring another digital health company, this time eying the wellness market and an app already in use by thousands of members at a rival health plan.
The increasing incidence of chronic diseases, aging populations, emphasis on diagnosis and disease monitoring and more advanced testing technologies and practices are driving increased use of clinical lab services.
Humana is being sued by an individual policyholder claiming he has been unable to cancel the plan despite months of trying, in what may be first such lawsuit over insurance company practices during the transition to ACA-compliant health plans.
The Department of Health and Human Services is constantly promoting Medicare and the Affordable Care Act, but some Republican senators are getting annoyed with one slogan: "free preventive services."
Yesterday the American Hospital Association, four regional hospital associations and four health systems launched a federal court challenge to the controversial two-midnight inpatient admissions policy established by the Centers for Medicare & Medicaid Services.
Continuing a trend in the retail economy, Target is ending health insurance options for part-time employees and sending them to health insurance exchanges, following the likes of Home Depot and Walgreens.
Target has decided to stop offering health benefits to part-time employees. The mainstream news angle is that Target's benefit policy decision shows yet another flaw in the Affordable Care Act (aka ObamaCare). People are losing coverage, all because of the new rules. I really don't agree with that.
In 2007, BCBS of Massachusetts asked Lowell General Hospital to accept a monthly capitated payment to care for its HMO members. The hospital simultaneously saw the potential and recognized the risks.
If you are responsible for fighting fraud, waste and abuse (FWA) at a health plan and you are using rules-based approaches alone, you could do better.