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Editorial

2015: The perfect storm has arrived

Ray Desrochers, HealthEdge

There is little doubt that the perfect storm is here. A combination of regulatory requirements, changing employer attitudes and consumer buying habits has hit hard, and health insurers are taking the appropriate steps to ensure that they don’t become the next Andrea Gail. For many health plans, 2015 will be the year of technology.

Payment integrity in the post-reform era

Paul Vosters, Discovery Health Partners

Many payers face profitability declines while also taking in a huge influx of newly insured members whose risk profiles are unknown. Payers continue to see billions of dollars in error rates on claims each year, and fraud and other abuse further erode the bottom line.

Feature Video

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.

One Medicare Advantage company offers a parable for what can go wrong in the business of managed healthcare.

Private physician practices may soon be a thing of the past, according to a new survey that shows them dwindling year over year as more doctors opt to become part of a hospital or health system.

Deep inside the massive short-term spending bill awaiting President Obama's signature are provisions that could rattle the insurance industry.

WellCare has been trying to shake off its past transgressions and grow amid speculation of being a target for acquisition, and now its executive suite is ready for business.

The pressure is growing on Republican Governors to expand Medicaid in some way, and more state executives are turning to managed care and market-based approaches to bring in federal dollars.

The nation's largest insurer is starting a new bundled payment pilot in oncology with one of the most prestigious providers in the field, in an experiment they hope will be yield beneficial evidence and grounds for expansion.

One of the nation's largest health systems is struggling with its new health insurance business, leading to the first loss in 15 years.

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