Reimbursement

One of the country's oldest provider-owned health plans is being acquired by Blue Cross and Blue Shield of New Mexico, a division of Health Care Services Corporation.

Hanging above physicians like the mythical sword of Damocles, the sustainable growth rate (SGR) provision threatens to impose a 24.4 percent decrease to the Medicare Physician Fee Schedule on Jan. 1, 2014.

Three federal agencies have finalized long-awaited mental health parity regulations, expanding group and individual access to substance abuse services and with it, spending.

The Department of Defense has been testing patient-centered medical home models longer than most payers in the Military Health System, which could offer lessons in team-based care for civilian providers, according to researchers writing in Health Affairs.

Health plans are evolving into customer-oriented organizations as a result of the Affordable Care Act and requirements for transparency and more value. One way insurers can help their customers is to tie together their front- and back-end systems to focus on the consumer's needs and experience, according to Dell Services.

Perhaps more than ever before, payers are trying to encourage lifestyle changes in their most at-risk members, sometimes bypassing providers with the opportunities of the Internet and mobile technology.

Reference pricing is a great cost-saving idea and I'd like to see more of it. But it’s a pretty poor argument for the superiority of the free market in healthcare.

Areas in which a few health insurers are concentrated can put independent physicians or small practices at a disadvantage because they don't have the muscle to negotiate from a strong position with the dominant payers, the American Medical Association said in a report.

One of the most difficult goals of health reform is price transparency -- and one of the biggest uncertainties is whether more transparency will necessarily lead to higher value.

Now that the health insurance exchanges and other parts of the Affordable Care Act are being rolled out, providers, payers and other organizations are eyeing what it will take to keep making progress in 2014 and beyond around health reform.