Healthcare Finance Staff

Imagine an altogether different kind of utilization management that both payers and providers appreciate, where approvals are made at the point of decision, not after the fact. Utilization management as we know it is flawed. But keeping some semblance of the old model is necessary and a smart way to move forward.

Linda Burt, Chief Financial Officer for Nebraska Methodist Health System, talks about how her organization has adapted to the ever-changing financial landscape in healthcare by adding specialized staff and adopting new technologies.

Blue Shield of California is in the position of trying to keep its state tax exemption, while also defending its public image and defining its future mission to customers.

Can the federal government subsidize private health insurance without regulating it?

How much overhead in private and government insurance will it take to have universal coverage under the ACA? Quite a bit in one current view of the data.

Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them into smart shoppers. So he shopped.

After more than a decade of legal turmoil, physicians in four states have won a concession from the nation's largest insurer to make getting paid less of a hassle, if not to get paid more.

The federal government has crafted the first regulatory change to Medicaid managed care in a decade, as more health plans take the challenge from states to cover growing Medicaid populations at a sustainable cost.

Health plans' current wellness initiatives and disease/case management programs may be leaving members who fall outside of the "very sick" and "healthy" categories unengaged.

As California goes, so goes the country in capping consumer costs for medicines? That's what patient advocacy groups and and some pharmaceutical companies may be hoping.