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Hospital-owned physician practices skew to high spending


Hospital systems buying up medical practices cite integration efforts and payment reform as a justification. Now, though, payers might rightly be concerned about where the trend can lead at local levels. Read more »

New insurer tries old distribution option


Amid a mulligan of sorts for a large state insurance exchange, an insurer with a new mission is using the old tactic of tapping brokers in a bid to vie in the big leagues. Read more »

Referral, venture scheme ends in $389M settlement


The federal government is clamping down hard on some profit-focused patient referral and healthcare joint venture practices, although the company in question appears unfazed as it enters new forays, including some with insurers. Read more »

Sustaining the 3Rs' give and take


Will the pay-ins and payouts in the 3Rs be enough to leave insurers, and the programs, whole? Early data is offering a window into the possible dynamics.  Read more »

Payer IT company goes to Wall Street


An established but growing player in the health insurance technology space is looking to get big and serious. Read more »

Cardiac stress imaging fraught with unneeded risks


As cardiovascular disease becomes a greater risk for both older and younger Americans, there may be new grounds for steering members away from traditional diagnostics. Read more »

Variation in essential benefits clouds new plans


"Isn't that covered by ObamaCare?" Public understanding of the Affordable Care Act has not been great, with a fair amount of confusion about key provisions and benefits detected by surveys. Read more »

Some Blues trapped in a business tower


Insurers that trace their ancestry back to the first days of American health insurance are now facing potentially existential challenges. Read more »

Revenue sustainability key to kicking FFS


Trying to wean themselves off fee-for-service reimbursement, some health systems may be taking a non-committal strategy, dipping their toes in the water before deciding if they want to learn to swim. Insurers should be looking for more than that, if they can offer the right expertise. Read more »

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 »

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