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Editorial

Payer-provider transactions are evolving

Tom Dean, Emdeon

Like many other industries, from manufacturing to retail, healthcare is looking to use information technology to transform and automate financial payments. Providers, though, have a lot of old and new choices.

A more complete picture of Pioneer ACOs

Larry Kocot and Mark McClellan, MD

The Centers for Medicare and Medicaid Services recently released more detailed ACO-level data for participants for the first two years of the Pioneer ACO Model. Despite the decline in participation and mixed results so far, upcoming regulatory may help.

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.

Passing a key corporate milestone, UnitedHealth Group is on track to have a banner year, while trying to reshape large swaths of American healthcare.

Where time equals brain in preventing death, disability and millions of dollars in spending, insurers and providers have a huge opportunity to try an approach that can pay for itself.

Insurers are trying to use a new model to improve treatment in costly, difficult chronic diseases like Crohn's, and rationalize reimbursement.

How did one large employer keep its healthcare costs flat for six years? A wide-ranging wellness program, provider bidding and "enlightened consumerism."

Some health systems are seeing value in becoming part of branded health plan networks for limited provider plans, as other providers try to launch their very own plans.

Tech giant Google is trying out the telehealth waters with a video-based platform that connects consumers searching online for health data with physicians.

A new molecular diagnostic approved by Medicare and Medicaid is among the first non-invasive alternatives to colonoscopies, a potential boon for patients and payers but also a new piece of the personalization puzzle to manage.

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