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Garden State Blues bank on PCMH


New Jersey's largest insurer is expanding its medical home program in an effort to boost primary care access and member satisfaction, as new competitive threats loom from non-traditional insurers. Read more »

Aetna sees bright future despite uncertainty


Aetna is positioning itself to ride out the early storms of health reform and end up plying the new waters sustainably. Read more »

Highmark concedes in maternity access fracas


Pennsylvania's largest insurer has agreed to a broader interpretation of continuity of care provisions in a long-term accord with its main rival, while also touting what it sees as positive membership choice trends. Read more »

Low-cost options for colon cancer prevention


Not everyone who could benefit from colon cancer screening is enthusiastic about receiving the invasive "gold standard" diagnostic. It can also be expensive for insurers, unlike other options for patients. Read more »

Payer, doc collusion built lab empire, patients allege


The nation's largest laboratory company and two big insurers stand accused of creating a diagnostic monopoly that hasn't passed on savings to consumers. Read more »

Sutter, Blue Shield come to resolution


A short-lived network dispute has come to a resolution. But that doesn't mean the points of contention are going away. Read more »

Partners' conditional consolidation plan blocked


One of the most fractious hospital acquisition disputes in the country has come back to square one, in a potential win for payers and antitrust advocates. Read more »

3 changes needed to scale public, private ACOs


The ambitious new value-based healthcare coalition, including Aetna and HCSC, is wasting no time dispersing ideas. Consensus on reform may be difficult, and the work ahead even more so. Read more »

The steady decline of employer-based insurance


When Ken Fasola was working at Humana and UnitedHealth Group in the 1990s and 2000s, the industry saw individual insurance products as "the bottom end of the food chain." Read more »

Drug formularies pushing bounds of adverse selection


Insurers have to improve consumer education about drug formularies in exchanges, at the least, and some may even have to change their practices to meet new health reform standards. Read more »

Humana taps new model for nephrology SNP


Humana and DaVita are joining forces to try out a new way to serve high risk, special needs patients with a primary care-led model. Read more »

New frontiers in Medicaid privatization


Indiana is pushing the bounds of Medicaid with the first-ever consumer-driven health plan for low-income populations. It's opening up new possibilities for other right-leaning states, but testing federal limits. Read more »

Healthcare giants make value-based payment pledge


With and without government, some of healthcare's largest businesses, and those who pay for it, are mapping their own path to a critical mass of value-based payments. Read more »

Co-op headed to liquidation


One of the country's most promising new insurers could not be saved by state regulators. For some local advocates and insurance veterans, it is an opportunity lost to health reform policies gone awry. Read more »

Photos: The Blues' 'Live Fearless' campaign


More than a dozen Blues are trying to attract the next generation of members and help keep current customers as they age. To do that, they're invoking old school insurance ideas for the modern world. Read more »

Feds outline ambitious quality vision for Medicare


The U.S. Department of Health and Human Services wants have 50 percent of Medicare reimbursements tied to quality and value by 2018, even if that includes fee-for-service. Read more »

Flawed data, calculations may skew state's risk adjustment


One state's home-grown approach to health reform has produced a few discrepancies in the implementation of the Affordable Care Act, including one big dispute between insurers over risk-sharing. Read more »

Insurers investing enough in innovation?


Are the two biggest forces in American healthcare, health insurers and health systems, investing enough in research and development? Read more »

Cigna scoops up hospital-owned plan


Cigna is acquiring a hospital-owned managed care company that serves a fairly diverse customer base of employers, providers and even potential competitors. Read more »

Big Blue and Big Blue: Anthem turns to IBM's cloud


In a deal showing just how massive and pivotal the quest is for digital modernization, Anthem is investing half a billion in a flexible, scalable cloud. Read more »

Striving for 'well-being' amid the wellness backlash


Until corporate wellness programs demonstrate ROI, many companies have to consider whether there are other ways to improve the health of their employees and the country. Read more »

Aetna wins lower costs for hep C breakthrough


The nation's third largest insurer is the latest to find a cheaper way to bring a curative therapy to members with Hepatitis C. Read more »

UHG ahead on ACA enrollment, forecasts profitable 2015


Notwithstanding resistance in California and some long-term uncertainty, the nation's largest insurer is pretty stoked about 2015, public exchanges and Medicaid. Read more »

Provider plan sets sights on Medicare Advantage


In a crowded market dominated by the Blues, a hospital-owned health plan is trying grow in tandem with Medicare and Medicaid enrollment, seeing potential in suburban Baby Boomers. Read more »

Amid prevention push, perils in screening


At a time when prevention is being hailed as a key to health reform, indeed required as an essential health benefit, new evidence is questioning assumptions about the benefits and costs. Read more »

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