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Re-enrollment policy would benefit and challenge insurers

The Obama Administration wants to make it as easy as possible for the 8 million Americans who bought insurance via an exchange last year to keep their plans. To that end, the auto-enrollment policy Health and Human Services unwrapped aims to reduce complexity for insurers, but it also brings new issues. Read more »

Small state runs big experiments with alternative payments

Two large players in a small market are going to spend the next three years trying to collaborate with emerging incentives, as shared risk becomes the new normal. Read more »

Consumer choices heating up in exchanges

The individual insurance market is now too big to ignore, drawing new crowds on and off state exchanges. Read more »

Looming diabetes crisis spurs call to preventive arms

As health plans start serving newly-insured populations and try to improve outcomes for long-time patients, all while taking on more financial risk, the case for aggressively targeting diabetes and obesity has never been greater. Read more »

Ambulatory surgical centers proving less-costly than hospitals

The ambulatory surgery center movement has some evidence to back up arguments for its relative cost-effectiveness, although variation can still be vexing for health plans and patients. Read more »

Insurers invest in obesity, diabetes intervention for new populations

The nation's diabetes and obesity crises have started taking their toll on healthcare spending, and some insurers are stepping in before new generations develop these problems in the long-term. Read more »

Single-carrier HIX model gaining traction

Just as government marketplaces are transforming their individual policy businesses, Blue Cross and Blue Shield companies are setting up private exchanges to save a far larger source of traditional revenue. Read more »

Cautious but competitive, HIX plans get good credit ratings

Insurer premiums in the second year of public exchanges look financially wise to credit experts, although there are also some double-edged swords. Read more »

Big turn out for state Medicaid exchange plan

Even before federal approval is won for the experimental program, insurers in one large state are ready to start selling exchange plans to Medicaid beneficiaries. Read more »

UHG VP lands CMS job, HIX gets new executive roles

After the botched rollout of insurance exchanges last year, the federal government is trying to get the technology right for what promises to be just as big a consumer turnout this fall. Read more »

ACO startup wants to lead crusade of the independent practices

A new start-up is hoping to become the largest enabler of primary care in the country within six years, by letting independent docs start ACO networks and stay free of the hassle of hospital systems and payers. Read more »

Aetna tries to make commercial ACO viable

Aetna is extending its ACO network and health plan offerings in America's heartland, trying to meet promises of bringing accountable care to the commercially-insured masses in competition with United and WellPoint. Read more »

High court could throw more wrenches into ACA

Any day now, the Supreme Court will issue its decision on the "contraception mandate" and could add more complexity to health plan administration, while another dispute may spell even more trouble. Read more »

In 2015, HIX premiums to balance affordability, competition

Insurers that have submitted applications to sell exchange plans are currently waiting, hoping regulators will approve their premiums and that consumers will find them affordable, in what will be a more crowded marketplace. Read more »

Before managed care boom, state modernizes program

The state of Illinois is nailing down key Medicaid policies ahead of a massive managed care rollout and accountable care experiment. Read more »

Insurer gets a win in chargemaster dispute

WellPoint has won the right to challenge a hospital's chargemaster billing practices, but the ultimate resolution could still disrupt relations with a key provider in a large market. Read more »

Medicaid capitation spurs ACO model

A health plan and a health system are preparing for the rise of capitation in Medicaid with a new care management venture, as more state programs try to phase out fee-for-service. Read more »

Formulary changes end fight over mail-order Rx

Pressure is growing on insurers to stop using mail-order pharmacies for speciality medications, and also on benefits managers to find new ways to get lower drug prices. Read more »

IRS needs to clear ACA tax uncertainty

Even amid delays in enforcement of the Affordable Care Act's employer mandate, tax and reporting regulations are sowing confusion among employers and putting large businesses on edge. Read more »

Innovative ACO options available for Boeing workforce

Two accountable care networks spanning three health systems have landed contracts with one of the country's largest private employers, in a model that could leave traditional players behind. Read more »

Infographic: Insurers respond to rise of private exchanges

In the midst of the exchange evolution, insurers are taking some common but also some diverging paths when it comes to the private HIXs transforming the group market. Read more »

Bridge between insurers, providers helps patients pay their shares

Amid the shift to high-deductible health plans, patients are finally getting more convenient options to pay for their health services up front. Read more »

Nailing down the definition of 'team-based care'

Phrases abound for the imminent future of team healthcare. Whether it's accountable care, coordinated care, medical home, or even the uber-approach of patient-centered medical community, the underlying notion is that all caregivers practice at the top of their license to essentially put patients front-and-center. Read more »

Time for a chief population health officer?

With population health management becoming a central focus for more healthcare providers, a growing number are considering adding a chief population health officer to the executive ranks. Read more »

Challenges to come from government payers, but also more business

Healthcare companies working for publicly-funded programs have one certainty: they will be serving many more Americans getting public coverage, at the same time they will have to bring down the cost-curve. Read more »


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