Healthcare Finance Staff

A critical best practice for building an exchange that can operate as expected on day one was learning to say "no," according to the experience of the executives leading the Connecticut and District of Columbia health insurance marketplaces. 

Pennsylvania is asking the federal government to experiment with a range of healthcare delivery and payment reforms, and Medicaid is being eyed as a good fit for the patient-centered medical home.

Call 2013 the time that ICD-10 stood still. Certain facets of the industry may actually be less prepared than last January, while some organizations made industry-leading strides.

It's been rare that state credit ratings have been driven by Medicaid budgets, but that could be changing. 

Despite the noise around the higher cost of some health plans on the exchanges, rate increases generally have more to do with the trend of steadily higher medical costs than with provisions of the Affordable Care Act.

Global pharmaceuticals and healthcare products company Abbott Laboratories has agreed to pay the United States $5.475 million to resolve allegations that the company violated the False Claims Act by paying improper kickbacks to induce doctors to use some of its products.

President Barack Obama gave doctors a holiday gift of sorts at the end of the year when he signed the Pathway for SGR Reform Act, sparing physicians and other practitioners who treat Medicare patients from the 24 percent payment reduction previously slated to take effect the first of the year.

Humana and Minnesota-based Healthsense, a provider of aging services technologies, have enrolled Medicare members with chronic health conditions in a pilot to measure the impact that in-home sensors and remote monitoring technology have on improving health outcomes and reducing frailty and fall-related hospital admissions.

Medicaid directors in the 25 states, plus D.C., expanding eligibility are cautiously optimistic of the benefits, but they're also expecting new costs from some potentially overlooked areas and they're not entirely trustful of Congress.

With one open enrollment period closed and another beginning, HealthCare.gov and state exchanges have sold about 20 percent of the number of health plans that federal budget officials think is enough for a sustainable risk pool.