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Feds look to limit group plans without hospitalization coverage

Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don't include hospital benefits. Now the administration is concerned too. Read more »

30 years a giant, UHG marches on

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

Population health investments with real ROI

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. Read more »

Medical home evolves for speciality care

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

Proving ground for exchanges and consumer experience

As a microcosm of American health insurance markets, with both old and new regulations and business trends, one corner of the country offers a window into the future. Read more »

The company that kept premiums flat since 2007

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

Regional health system brands its own network

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. Read more »

Google may be an option for telehealth

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

Renewals, new customers to bring flood of HIX complexity

It's almost game day for the second season of ACA insurance exchanges, and insurers need to get ready to handle all sorts of consumer inquiries and administrative tasks. Read more »

Are insurance markets too concentrated?

The competitiveness of America's state and regional health insurance markets is once again under question as patients and providers demand greater value propositions from payers. Read more »

At-home diagnostic tool may improve colon screening

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. Read more »

Seniors to see new cost-sharing, benefit options

Cost-sharing in traditional Medicare is on the rise, and benefit designs in Medicare drug plans are changing. Read more »

Complications, costs to consider in robotic surgery reimbursement

As more providers adpot robotic surgery technology, more information on comparative effectiveness is raising questions about costs and benefits. Read more »

State Medicaid units divided on approach to Sovaldi

The new hepatitis C treatment Sovaldi has driven debate over drug costs for close to a year, but it’s also been a case study in access and coverage in public payer programs. Read more »

Hospitals try to absorb shortfalls

In one large state, it is up to individual hospitals and health systems to find creative ways to bend the cost curve and best meet local needs. Read more »

Tiered network rankles Highmark, UPMC accord

In a new market for western Pennsylvania healthcare lives, Highmark and UPMC are finding old disputes lurking, adding to consumer confusion amid a new product launch and open enrollment. Read more »

CMS clarifies ACA Medicaid tax

Insurers with Medicaid managed care plans can breathe one big sigh of relief, but there are still other things with the insurance fee in Medicaid to worry about. Read more »

Big Pharma's long road to mobility

The industry that prides itself on being at the cutting edge of biomedical research is at the back end when it comes to adopting mobile technology for healthcare professionals and patients. Read more »

Rule changes will shake up plans serving those with disabilities

Insurers that manage long-term care and supports for individuals with disabilities in their home or community will have to assure that beneficiaries can interact with their community and make more of their own life choices. Read more »

Pay-for-performance: Patient-centered care or just bureaucracy?

After years of research, design, pilot programs and technology investment, the movement for quality improvement and pay-for-performance is facing skepticism from outside and within. Read more »

What payers need to know about the new HP

Hewlett-Packard revealed on Monday that it intends to break itself into two distinct entities and, in so doing, shared a little about how it will all work. Read more »

How big is too big for hospital consolidation?

In Massachusetts, the expansion of the state's largest health system is offering a fractious case study of clinical integration and payment reform. Read more »

Walmart targets complexity with broker venture

A few months after opening its own primary care clinics, Walmart is expanding its insurance sales program, in what could be another step toward underwriting. Read more »

Medicaid providers seek right to sue for payment increases

In the many quests for sound Medicaid reimbursement, healthcare provider advocates may soon have another tool to compel state governments. Read more »

End to Medicaid primary care bump raises sustainability questions

Health plans, providers and legislators need to increase the number of primary care practitioners participating in Medicaid as the wait for many to access care is inadequate and getting worse as enrollment mushrooms. Read more »


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