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Co-op on the brink of bankruptcy


Of all the new cooperative insurers, the one led by a Blue Cross veteran attracting droves of exchange and employer members might seem the least likely to fail. Now the success of every co-op will be in question. Read more »

Breakthrough enables PBMs to cut out Sovaldi


In the war for affordably treating the hepatis C liver virus, pharmacy benefits managers are fighting back now that alternatives are becoming available. Read more »

Anthem scoops up HMO to boost government business


As the second largest health insurer formerly known as WellPoint nurtures the new corporate Anthem brand, it's also continuing to grow its presence in the government-funded health plan space. Read more »

Federal budget brings Blues MLR relief, 3Rs mandates


Deep inside the massive 2015 federal budget are provisions that could rattle the insurance industry as a whole, while also benefiting a few. Read more »

Insurance commissioner balks at Aetna small group hike


Despite failing to win rate rejection authority from voters in November, one insurance commissioner is trying to protect the market by other means, calling out carriers for what are deemed to be "unreasonable" rate increases. Read more »

The payer-provider collaboration impetus


To move beyond the marketing buzz of "population health" and, in some places, to avoid being usurped by provider-sponsored plans, insurers need to see provider contracting more as a partnership for a community's healthcare and wellness. Read more »

Premera takes comprehensive telehealth strategy


Another health insurer is investing in a digital differentiator, offering members access to telehealth and choices in using it. Read more »

Regence bets on 'accountable health' group plans


One Blue insurer will find out just how much employer appetite there is for health plans with limited but transparent networks branded as both accountable and affordable. Read more »

Vermont abandons single payer, for now


The land of the Green Mountains, dairy farms and maple syrup is no longer pursuing the progressive dream of a single payer healthcare system, although it may still be on the vanguard trying to regulate affordability and access. Read more »

Medicare Advantage HMO dissolves amid fraud charges


One Medicare Advantage company offers a parable for what can go wrong in the business of managed healthcare. Read more »

Class action suits mounting for ERISA plan clawbacks


A fractious and potentially costly family of provider-led class action lawsuits are moving through courts, pitting accusations of illegal clawbacks againsts the likes of Aetna and UnitedHealth Group. Read more »

Private doc practices seem to be going extinct


Private physician practices may soon be a thing of the past, according to a new survey that shows them dwindling year over year as more doctors opt to become part of a hospital or health system. Read more »

WellCare ends long search for CEO, eyes earnings


WellCare has been trying to shake off its past transgressions and grow amid speculation of being a target for acquisition, and now its executive suite is ready for business. Read more »

State floats HRA, ESI vouchers for Medicaid


The pressure is growing on Republican Governors to expand Medicaid in some way, and more state executives are turning to managed care and market-based approaches to bring in federal dollars. Read more »

UHG, MD Anderson pilot bundled oncology payments


The nation's largest insurer is starting a new bundled payment pilot in oncology with one of the most prestigious providers in the field, in an experiment they hope will be yield beneficial evidence and grounds for expansion. Read more »

For powerful health system, growing pains with new health plan


One of the nation's largest health systems is struggling with its new health insurance business, leading to the first loss in 15 years. Read more »

Will payment reform really improve the status quo?


Once in a while, a key voice in the reform movement turns out to be a skeptic, arguing that the changes being implemented are too prone to producing more of the same. Read more »

Public employees plan takes Sovaldi cost to court


The latest salvo in the pharmaceutical price wars is being launched from an unlikely outpost, but one that represents the struggle to pay for the year's most successful drug. Read more »

Young invincibles want to pay for low-deductible plans?


A young adult generation with college debt, limited assets and an uncertain job market who rarely need to use the healthcare system should be prime customers for low-premium, high-deductible health plans. Not so, some data suggests. Read more »

Co-op pricing puts pressure on old guard


A large handful of cooperative insurers created through the Affordable Care Act have lowered 2015 premiums in a bid to boost membership in their second year of operation, upsetting traditional insurers. Read more »

New insurer links wearables, rewards to consumer-friendly strategy


A startup health insurer trying to capitalize on digital services and simplicity is now offering members wearable devices and incentives for activity, another step in its bid to disrupt health insurance. Read more »

Blue Shield of California breaks into Medicaid market


California's second largest nonprofit insurer is using a strategic acquisition to enter a growing, but challenging sector of government-funded health plans. Read more »

Little relief for workers in health spending trends


Record low healthcare inflation does not seem to be trickling down to average middle income consumers with work-based insurance. If anything, more Americans may be questioning the value of their employer health plans amid wage stagnation. Read more »

A short but necessary delay for EDGE data


No deadline is ever really certain. The federal government is giving health insurers more time to submit data for the risk-sharing programs that many market reforms are depending on. Read more »

The ACA contracting boom


In a way that is deeply changing federal contracting, growth opportunities from the government have increasingly come not from war but from healing. Read more »

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