Healthcare Finance Staff

Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country.

With a banner of its logo draped over the New York Stock Exchange on the Friday before St. Patrick's Day, Castlight Health went public, in another sign that reducing friction and opacity in healthcare is sparking a gold rush of sorts.

Depending on the outcome of a lawsuit Cigna is pursuing in Los Angeles, more out-of-network providers may be able to offer patients discounts while billing health plans in full.

Studies and predictions around customer engagement and behavior trends focus on the empowered, online consumer. Forbes and Marketo cite that consumers expect super-personalized communications, consistent multi-channel interactions and sleek efficient tools. Payers are hit with delivering against these heightened expectations while responding to a host of new regulatory requirements. Luckily this double whammy has a silver lining; the technologies and tools that consumers demand can improve subscriber loyalty and the bottom line.

With researchers expecting a lot of fluctuating eligibility between Medicaid and exchange subsidies among lower-income consumers, states and insurers will have to devise new ways to solve the problem of continuity of care disruptions.

The drug formularies of some small group health plans in two states don't meet essential health benefit benchmarks, a new study has found, leaving researchers pointing to a solution that may be as complex as benefit mandates.

Federal healthcare auditors think Medicaid managed care organizations aren't doing enough to combat fraud and that states might have to step in with policy changes.

Through the beginning of March, 4.2 million Americans signed up for private coverage through state and federally-run exchanges, leaving federal health officials hoping for a final month's surge to meet initial projections, especially for millennials.

Aetna is going forward with an accountable care agreement for some 28,000 people, partnering with a health system that also has accountable care contracts with some competitors.

WellPoint's Amerigroup is the first Medicaid plan in the nation to use a health record chip that enthusiasts are calling a "breakthrough health IT solution."