News

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.

Among the major changes proposed for Medicaid plans are new provider adequacy standards, new mandates for capitated rate setting, beneficiary protections in long-term care, forthcoming quality ratings, and an 85 percent medical cost administrative ratio.

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.

The most difficult challenges to value-based reimbursement reside within the cultural and operational sides of the business, and not technology, experts say.

New Hampshire ACO's goal is to have capitation make up 70 percent of reimbursements, dropping fee-for-service from its current 50 percent to 30 percent.

The move could affect 3,500 UPMC employees who are at least 60 years old and have 10 years on the job.

Seven cooperatives will split the funds.

Trinity Hospital Twin City CFO Woodrow W. Hathaway Jr. retires after 41 years in the healthcare industry.

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.

Dr. Aria O. Sabit profited by convincing patients to undergo spinal fusion surgeries with instrumentation that he never used.