Healthcare Finance Staff
States that continue to resist the Affordable Care Act (ACA) are finding themselves in a tougher and tougher spot. It's hard to retain ideological purity while dealing with the nuts and bolts of implementation. Exhibit A is the health insurance exchanges. States can run their own exchanges, but those that decide not to act will find the federal government running their exchanges for them. So you will have the weird phenomenon of blue states running their own exchanges and red states ceding authority to the feds.
WellPoint's board of directors have selected a health system executive, Joseph Swedish, to head the company after last August's investor-stoked departure of Angela Braly.
As the IRS finalizes regulations for the Affordable Care Act's individual and employer mandates, the complex eligibility and exemption framework being proposed has some legal analysts worried that working families in certain income brackets won't be eligible for premium support.
Out of the 258 accountable care organizations (ACOs) recognized by the Centers for Medicare and Medicaid Services, 60 of them, across more than 15 states, have banded together to form the National Association of ACOs.
Methodist Health Services Corp., a Peoria, Ill.-based health system, has filed a lawsuit accusing the region's largest provider of breaking antitrust laws with "exclusionary" contracts that limit commercial insurers' ability to contract with other hospitals.
The association between mental health and physical health has a long history, yet the two disciplines often are viewed as disparate pieces of patient care. Making this link between a patient's physical and mental well-being is becoming paramount in terms of streamlining a patient's medical lifecycle. Bridging the gap is essential for creating a smarter roadmap to understand these cause-and-effect relationships and ending this false duality.
When deductibles are taken into account, about one-third of individual and family health plans currently exceed the Affordable Care Act's baseline limit on out-of-pocket expenses, researchers at the consumer website HealthPocket.com estimate.
Humana reported its earnings sank 3.5 percent in the fourth quarter 2012 from the previous year, as the insurer made investments to build its own integrated care network and reported more than $75 million in flu-related expenses.
For Medicare Advantage and prescription drug plans, the pressure is on to improve quality or miss out on incentives under the Centers for Medicare & Medicaid Services (CMS). Specifically, under the agency's Five Star Quality Rating System, plans that achieve and maintain a rating of 4.5 or above will have the opportunity to enroll beneficiaries throughout the 2013 plan year under a newly created special election period.
Now that the Affordable Care Act has survived the Supreme Court ruling and the presidential election, one of last year's other big issues is moving to the forefront for 2013: reimbursements.