Reimbursement
With the insurance and healthcare landscape in this country changing on almost a monthly basis, payer software vendor HealthEdge has begun conducting regular surveys of insurers as a means to take the pulse of a market at any given time. The surveys, conducted currently at six-month intervals provide a snapshot of the industry.
The Illinois exchange wants to offer in-person consumer assistance in addition to federal navigators, as part of the partnership exchange. Covered California is pretty much covered financially until 2015 with federal grants. And as Wal-Mart expands into healthcare, HHS has rebranded exchanges as "marketplaces."
As Aetna finalizes the acquisition of the managed care insurer Coventry, it is selling one of its own Medicaid businesses, Missouri Care, to WellCare Health Plans, for an undisclosed sum.
Last week the Department of Justice (DOJ) announced that it will not challenge a proposal by the Greater New York Hospital Association (GNYHA) to offer a gainsharing program to its member hospitals in the state.
If hospitals launching health plans strikes some as a sign of traditional health insurance's coming extinction, the business model so many American hospitals were built upon -- fee-for-service -- is declining too. Integrated healthcare and shared savings contracts between payers and providers are going to become the norm.
Eleven states have received $1.5 billion more in grants from the Health and Human Services Department to support their creation of health insurance exchanges, which must be ready in October for enrollment season.
As healthcare providers brace themselves for big changes to reimbursement models, many are taking a conservative approach to their capital budgets. As a result, capital spending in 2013 will likely be flat or slightly down compared to 2012, predict experts at several healthcare group purchasing organizations.
Uwe Reinhardt had a post the other day at The New York Times economics blog comparing Medicare with Medicare Advantage (MA) plans. He basically sifts through the evidence on which is less costly: Medicare (a public plan) or the private MA plans. But while his column is definitely worth reading, it does not go far enough.
The most eagerly awaited -- if not anxiety-laden -- set of regulations in the healthcare spectrum arrived late Thursday: HHS issued modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules.
Highmark Inc., West Penn Allegheny Health System and a selected number of West Penn bondholders announced on Wednesday they had reached a financial settlement that would allow for a reduction in the debt load of the WPAHS and allow the proposed merger of Highmark and ailing health system to proceed.