Healthcare Finance Staff

With at least 15 percent of Americans now covered through an accountable care organization of some sort, integration seems almost inexorable. But not all is well in the land of Medicare ACOs, and in the private sector, the evolution may hit a few dead ends.

A recent analysis of the federal government's 340B drug discount program suggests that eligibility is too broad and that lawmakers need to tighten it, which may mean that hundreds of hospitals currently in the program would be booted out.

Growing more anxious about the impact of the expensive new hepatitis C drug Sovaldi and the routes states may take, Medicaid managed care organizations are looking for help.

How do consumers want to talk to their health plans? By any means possible, please, and right now.

Left as-is, current exchange formulary and network search technology has the potential for a lot of consumer dissatisfaction and backlash.

Cooperative health plans attracted more than 400,000 Americans during the first open enrollment period and, although their long-term viability is still not guaranteed, some are bullishly plotting to grab market share from incumbents next year.

Not-for-profit hospitals are facing huge revenue challenges amid payment reform and shifting payer mixes, leaving relationships with commercial insurers in a flux.

So far, 2014 is not looking too shabby for some large insurers. Aetna, the Hartford-based giant, raised its outlook following a record quarter, but that doesn't mean there aren't headwinds.

A small uproar over provider networks in public insurance exchanges in Washington state has led to a proposed, controversial fix that, if adopted, has implications for other states, providers and insurers facing similar situations.

The brains behind implementing much of the Affordable Care Act's new Medicare policies, Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, will be stepping down from his position on May 16.