Anthony Brino

The breakthrough hepatitits C drug Sovaldi has brought the high price of specialty pharma to recent public attention. But less examined are proactive approaches that could be used to curb the growth trend without depriving patients of needed therapies.

Medicare's ACOs have had mixed early outcomes, but some commercial accountable care ventures, including PPO plans, are showing promise.

Hospitals in states that have expanded Medicaid eligibility under the Affordable Care Act are already bringing in fewer self-pay and charity care patient cases, according to an analysis by the Colorado Hospital Association.

The American Hospital Association is asking federal Medicare leaders to stem the practice of using sample hospital audit data to extrapolate overpayments eligible for recovery. The lack of clarity regarding standards for short patient stays has clouded the issue.

States' taxing of Medicaid managed care organizations to raise revenue for state-share Medicaid payments may be illegal, according to the HHS Inspector General. If so, this raises serious questions that could shake up MCO financing models.

One third of Pennsylvania's hospitals had negative operating margins in the 2013 fiscal year, according to the Pennsylvania Healthcare Cost Containment Council, an independent state agency. The crisis is forcing health systems to rethink organizational mergers and management.

As the Department of Veterans' Affairs scandal grows, scrutiny of wait times at civilian hospitals and clinics is bound to as well. Health systems might start reviewing their own access metrics.

Medicare's accountable care organizations have gotten off to a mixed start, with hospital-led ACOs especially reporting financial challenges. By contrast, physician-led ACOs may have built-in advantages, and could be a new source of competition.

In the past year, several large insurers have hired executives from outside the industry, seeking to bring in new skills and perspectives to help improve the experience for customers increasingly demanding more price transparency and convenience.

A group of chiropractors went to war with the Blues and it seems they've won, successfully using a novel legal theory that now has lawyers setting their sights on other large insurers.