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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.

Experts say the California exchange uses more of its powers as an "active purchaser" than any other state. That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price.

Though President Barack Obama's proposed 2017 budget died almost as fast as it arrived at Congress on Tuesday, the chief executive's final proposal included millions in healthcare spending to bolster quality programs, improve interoperability and fight rising pharmaceutical prices.

Twenty major companies, including American Express, Verizon, Coca-Cola and HCA have joined the newly-launched Health Transformation Alliance to combine data on the population health of their employees, and potentially flex their muscle with insurance companies and big pharma, according to Tevi Troy, president of the American Health Policy Institute.

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.

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