Healthcare Finance Staff
America's medical cost inflation appears on track to fall even below 2013's trends, according to PricewaterhouseCoopers, although consumers are still bearing large cost burdens and other trends threaten the slowdown.
In one of the strangest Medicaid fraud cases in recent history, the Justice Department is charging several Russian diplomats and their families with illegally accessing Medicaid-covered prenatal and pediatric care in New York City.
A key component to making value-based payment models work is getting physicians on board. But while physicians are supportive of the improved care coordination of such models, they are wary of how the payment structure will work.
Many experts predicted that the opening of the healthcare exchanges would be rife with technological glitches. As it turns out, they were correct.
Aetna has formed an accountable care organization with PinnacleHealth System for its commercial plan members in the Harrisburg-Central Pennsylvania area, one of multiple value-based models launched recently in the state.
Existing market share has been a fairly good predictor of health plan participation in the federal exchange, although new entrants like CO-OPs may give some a run for their money, according to a Milliman report.
Whether it's guarding against "malicious insiders" or ensuring C-suite execs are scared straight about the risks and regs they face, the coming year poses big challenges to healthcare, according to Kroll's annual Cyber Security Forecast.
Medicare is expanding coverage for telehealth consults next year, as part of a gradual embrace of the technology that mobile and remote healthcare advocates have been hoping to accelerate.
When the Centers for Medicare & Medicaid Services announced the 2014 pay rates for physicians last week, the agency touted a final rule reflecting a shift to a greater emphasis on high-quality care and efficiency. Physician groups were unimpressed, instead keeping their focus on the sustainable growth rate (SGR) that the fee schedule maintains.
Self-funded employers with stop-loss coverage can breathe a sigh of relief now that the Internal Revenue Service finalized rules for new health insurance fees, but nonprofit HMOs banking on an exemption will have to pay up.