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Payers must change dynamic with providers to survive in the post-Affordable Care Act world

Suzanne Cogan, Orion Health

Finding the path to success in the post-Affordable Care Act world of healthcare represents a great opportunity and challenge for payer organizations. Part of that journey is changing the relationship dynamic between payers and providers.


Affordable Care Act rate stabilization program results should guide strategy for 2016

Lisa DiSalvo, Altegra Health

Earlier this year, the Centers for Medicare and Medicaid Services released the results of the first year of the reinsurance and risk adjustment provisions of the Patient Protection & Affordable Care Act.

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The Obama Administration recruited Seattle Seahawks quarterback Russell Wilson and cornerback Richard Sherman to the game of selling the Affordable Care Act.
 

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.

 

Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

Peter Lee said UnitedHealth made a series of blunders on rates and networks that led to a $475 million loss last year.

The last-minute surge lifted the total enrollment in Obamacare to 12.7 million this year, accounting for 9.6 million consumers enrolled or re-enrolled for coverage through Healthcare.gov and the 3.1 million people who selected plans through the state-based marketplaces.

Stung by losses under the federal health law, major insurers are seeking to sharply limit how policies are sold to individuals in ways that consumer advocates say seem to illegally discriminate against the sickest and could hold down future enrollment.

Pennsylvania-based Independence Blue Cross' announcement that it will cover a complex type of genetic testing for some cancer patients thrusts the insurer into an ongoing debate about how to handle an increasing array of these expensive tests.

North Carolina's average premium increases on the Obamacare exchange are among the highest in the country, according to federal data. The Obama administration warned this open enrollment period, which closes Jan. 31, could be particularly tough because many of the sickest, and therefore most motivated, people already bought plans.

The Centers for Medicare and Medicaid Services has proposed new rules it expects will expand access to analysis and data that helps employers and providers make more informed decisions about care delivery.

Health insurer Centene this week said the loss of six hard drives with health information in 950,000 beneficiaries was a result of an employee error.

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