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Provider network controversies from the first Affordable Care Act enrollment are coming back to bite two large Blues in the second open enrollment, while raising questions about responsibility for consumer confusion.

Accountable care organizations can be risky business. ACO care partners must be able to depend on one another for proper patient handling, data flow, clinical cooperation, revenue sharing and other agreed-upon measures.

The change from a fee-for-service healthcare model to a value-based approach might be inevitable, but that doesn't mean it's happening quickly. In fact, the majority of providers remain tied to the old model.

After several years of modest increases, U.S. spending on medications is projected to shoot up by 12 percent this year, pushing the nation's drug bill to between $375 billion and $385 billion.

California's experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.

Want to pay your health plan premiums while picking up medications, buying some batteries (or maybe a piece of chocolate) and getting a free cholesterol screening? Humana is betting that retail convenience will support its individual membership business.

A new payer-led patient information exchange in California is getting ready to hit the ground running.

The CFO of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, says the move towards value-based payment models helps the hospital emphasize value of care over volume, which reduces readmissions.

Shares of medical device maker Medtronic Inc. surged Tuesday after the Minneapolis-based company said it would go ahead with its planned $49.2 billion merger with Covidien.

Not only are employers prone to switching their health plans, but more are ending their group health benefits altogether, a sign of the growing importance of the individual market.