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McKesson and Health QX build alliance to help insurers use bundled payment models


McKesson Health Solutions and Health QX on Wednesday announced an alliance designed to help insurers quickly design and scale complex bundled payment models. Read more »

California wields power to decide which insurers can join the exchange, and at what price


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. Read more »

President's budget, dead on arrival, gives states incentives to expand Medicaid


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. Read more »

HCA, Verizon, among 20 major companies forming healthcare alliance to get data, control costs


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. Read more »

Covered California says UnitedHealth should own up to $475M loss and stop blaming Obamacare


Peter Lee said UnitedHealth made a series of blunders on rates and networks that led to a $475 million loss last year. Read more »

Open enrollment nets 12.7 million for Obamacare, exceeding expectations, HHS says


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. Read more »

Anthem, Aetna, Cigna among insurers trying to limit special enrollment signups, report says


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. Read more »

Blue Cross coverage of genetic testing for some cancers raises debate over expensive screenings


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. Read more »

Despite rate hikes, Obamacare sign-ups strong in North Carolina


North Carolina's average premium increases on the Obamacare exchange are among the highest in the country, according to federal data. The Obama administration warned this open enrollment period, which closes Jan. 31, could be particularly tough because many of the sickest, and therefore most motivated, people already bought plans. Read more »

CMS proposes sharing and selling analyses of claims data to improve care


The Centers for Medicare and Medicaid Services has proposed new rules it expects will expand access to analysis and data that helps employers and providers make more informed decisions about care delivery. Read more »

The pros and cons of short-term health plans


For some people -- especially those who are young, healthy and don't qualify for a tax credit from Covered California or other health insurance exchange -- short-term plans might make financial sense, even though they don't shield you from the Obamacare tax penalty. Read more »

Centene says hard drive loss due to employee error; Merger with Health Net expected early 2016


Health insurer Centene this week said the loss of six hard drives with health information in 950,000 beneficiaries was a result of an employee error. Read more »

Providers and insurers benefit from Medicaid expansion, former CMS director Cindy Mann says


Hospitals and payers benefit from Medicaid expansion, according to an attorney who formerly directed the Medicaid program for the Centers for Medicare and Medicaid Services. Read more »

Close to 9 million enroll in Obamacare as January 31 deadline nears, HHS says


With the final January 31 deadline for open enrollment looming, close to 9 million consumers have signed up for healthcare coverage through the marketplace, according to the Centers for Medicare and Medicaid Services. Read more »

CMS releases aligned payer and provider incentives for dual-eligibles


A longstanding barrier to improving quality and reducing costs of care for Medicare-Medicaid enrollees has been a lack of alignment and cohesiveness between the two programs, including misaligned incentives for payers and providers, according to the Centers for Medicare and Medicaid Services.

Read more »

CMS bars Cigna from enrolling new members into Medicare Advantage, prescription drug plans


Deficiencies found in an audit of Cigna-HealthSpring operations has prompted the Centers for Medicare and Medicaid Services to temporarily bar Cigna from enrolling new customers to its Medicare Advantage and stand-alone prescription drug plans, and from marketing efforts, according to CMS. Read more »

In second year of employer penalties, some work-based health plans exclude outpatient surgeries


Unlike insurance sold to individuals and small businesses through online marketplaces, large employers are not required to offer a list of "essential health benefits." 

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Centene loses six hard drives containing beneficiary data; pursues internal search


Health insurer Centene Corp. on Monday said it has lost six hard drives containing the health information of about 950,000 beneficiaries. Read more »

Open enrollment for Obamacare surges going into final week


Open enrollment for week 11 ended with close to 400,000 consumers signing up for healthcare coverage, a number four times greater than the week before, according to figures from the Centers for Medicare and Medicaid Services. Read more »

Pennsylvania insurance commissioner latest to propose protection from surprise balance bills


Pennsylvania Insurance Commissioner Teresa Miller was the latest state official to propose protections for healthcare consumers against surprise balance bills, when she announced new measures on Tuesday. Read more »

Private exchange enrollment tied to employer-sponsored plans jumps 35 percent, report says


Thirty-five percent more people than last year have enrolled for their employer-sponsored healthcare benefits on private online marketplaces, according to a new report from global consulting and technology firm Accenture. Read more »

UnitedHealth profits weighed down by $720 million loss from exchange product


Driven by a $720 million loss on its individual exchange product, UnitedHealth Group on Tuesday reported a $6.8 billion profit in 2015, down $238 million over its 2014 profit. Read more »

Lacking federal instruction, marketplace insurers leave out information on abortion coverage


As the third open enrollment period winds down on the health insurance marketplaces, one thing hasn't changed much since the online exchanges opened: It's still often hard to find out whether a plan covers abortion services. Read more »

Many who buy insurance on exchanges spend at least 10 percent of income on health expenses


Even with subsidies to make coverage more affordable, many people who buy health insurance on the marketplaces spend more than 10 percent of their income on premiums, deductibles and other out-of-pocket payments, a recent study found. Among those hit hardest, the researchers said, are people who spend nearly a quarter of their income on health care expenses. Read more »

Consumers can be confused by Medicaid and Marketplace coverage


For people whose income changes shift them above or below the Medicaid threshold during the year, navigating their health insurance coverage can be confusing. Ditto for lower income people who live in states that may expand Medicaid this year. Read more »

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