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As an alternative to traditional eligibility expansion, one Republican hopes to bring consumer-directed insurance to Medicaid while also bridging a gap in the lower end of the group insurance market.

Although accountable care organizations are still in their nascent stages, a few large provider groups and payers may be ahead of the curve on operations and performance.

Powerful social forces will drive the healthcare industry to innovate, overcoming institutional and political inertia, says healthcare consultant and futurist Ian Morrison. But things may not get 'serious' until 2018.

Next year, when Americans go looking for the best surgeon or cheapest MRI, many will have free access to a new comparison service started by three insurance giants.

Fifty years after the U.S. Surgeon General's report on smoking, it's still not uncommon to see workers puffing cigarettes on the grounds of hospitals. To address this incongruence, some health systems have started taking a bold strategy -- barring smokers from employment, even those who don't work in clinical and patient support roles.

Several million young people purchasing subsidized exchange plans was greated as a positive development for all involved. But being young does not mean being free from chronic or acute illness, as early data on one insurer's new enrollees shows.

With a new fiscal year approaching in many states, a big financial cloud is hanging over Medicaid managed care organizations: the Affordable Care Act's insurance fee.

As the federal government continues to cut reimbursements and private insurers follow suit, many CFOs are having a hard time justifying buying new property to expand services, however, in some cases, it shouldn’t be ruled out.

An extension of presumptive eligibility coverage takes away Medicaid payment uncertainty if hospitals make the effort to participate and follow the rules.

Modernizing code is essential for payers as technology ages and healthcare evolves. How does it work, and what's on the line?