Reimbursement

Although private exchanges exist today, the Affordable Care Act shines a greater spotlight on the "healthcare exchange" model.  Many commercial payers are considering private exchanges as part of their channel strategy. Private exchange requirements continue to evolve alongside public exchanges, particularly on plan pricing.

Insurance cooperatives and provider-owned health plans are vying heavily for small business customers in federally-run insurance exchanges, appearing alongside (or in the absence of) Blues and national firms.

Once individuals learn about the health insurance exchanges, a majority lean toward using them. The challenge is that so many consumers still are unaware of them.

S&P Dow Jones Indices has launched a new indicator that measures claims data from 33 leading health insurance companies and other organizations to calculate the growth in commercial healthcare costs.

Bobbie Kite, a doctoral student at the University of Texas School of Public Health, sketches out a breakdown of hospital chargemaster lists, thier role the current U.S. healthcare model, and implications of the ACA.

While some large insurers were reluctant to start selling lots of individual policies through the federal insurance marketplace, a number of Blues plans dove right in.

WellPoint Inc. has earned the status of Common Security Framework Certified from HITRUST, the information security and risk management organization, making it the largest health benefits company to achieve the certification for 2013.

Thanks to the Affordable Care Act, vital sexual health services for men and women are now covered by insurance plans at no extra cost. The law also ends annual and lifetime dollar limits on such care.

Firearm assaults cost U.S. hospitals almost $630 million in 2010 and alot of that falls on public payers, according to recent research by the Urban Institute.

New York City Mayor Michael Bloomberg's plans to re-bid the city workers' health insurance contract has come to a halt for now, after a state court agreed with municipal union concerns and put the request for proposals on temporary hold.