Reimbursement

The healthcare system has been pretty much a business-to-business sector, but from October, two big things change. Millions of unpredictable individuals enter the market as consumers, and the underlying risk calculation shifts from one that is largely clear and underwritten, to one that depends on a precarious balance.

I first posed the question "Could Mobile Health Become Addictive?" on August 20. Since then I've done more thinking, and I'm warming to the concept.

Many small businesses find the services offered by Affordable Care Act's SHOP exchanges attractive, but they're also interested in self-funding, a potential threat to the critical mass needed for HIXs to thrive.

The first insurer to report third quarter financials, UnitedHealth Group posted net quarterly earnings of $1.57 billion, a 1 percent year-over-year increase, with its Optum business contributing nearly 25 percent of profits.

Optum, part of UnitedHealth Group, and Dignity Health, one of the country's largest healthcare systems, have formed a revenue cycle management company, Optum360, that combines Dignity's revenue cycle management infrastructure and network scale with Optum's technology, analytics and broad client base of providers and health plans.

A new study indicates that 518 community health centers in the more than two dozen states not expanding Medicaid will lose out on $555 million next year.

The term "value-based" insurance might strike average consumers as a bit odd: Shouldn't all insurance be value-based?

Community health centers will pay a steep price for states' decisions not to expand Medicaid under the federal health law.

The chief architect of the Genetic Information Nondiscrimination Act is asking the Equal Employment Opportunity Commission to investigate the use of genetic data in wellness programs and offer compliance guidance -- while large employers are hoping for more flexibility in tying incentives to genetic screening.

Blue Cross Blue Shield of Michigan has launched an initiative using claims data to help hospitals across the state better understand their practice patterns compared with their peers, in an effort to improve patient outcomes and manage costs.