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Medicare Part D plans poised for low-cost choices

A shrinking number of Medicare Part D drug plans is set to bring beneficiaries some more low-cost choices, but also some potentially confusing benefit designs. Read more »

FTC spotlights reference pricing model's numerous problems

Federal trade regulators have proven their willingness to go after hospital consolidation. Now, they're raising some new concerns about an up-and-coming insurer strategy. Read more »

Medicaid, MCOs lag on beneficiary outreach

With enrollment at an all-time high and only increasing, state Medicaid programs and the health plans they contract with need to prioritize a few key areas of the beneficiary experience. Read more »

High rankings don't guarantee smooth sailing for plans

With the latest NCQA rankings come fresh marketing material and customer satisfaction bona fides, although that doesn't always inoculate them from having to explain coverage controversies in the media. Read more »

All exchange eyes on Wellmark

In terms of enrollment, which two states have the least successful health insurance exchanges? The ones where the largest insurer is setting out a key segment of the new market. Read more »

Highmark loses key client amid UPMC saga

Restricting access to prestigious, long-available providers can sometimes cost insurers long-held contracts and be competitive gains for others. Read more »

Medicare ACOs hatching their own insurance

With uncertainty in Medicare's accountable care program, some hospital systems are scrambling for long-term options and may give insurers a run for their money. Read more »

Learning from the past: Insurance marketing

From incentivizing wellness to protecting against catastrophic loss, what's old is new again in health insurance advertising. Read more »

CMS grants low-star Medicare Advantage plans mercy, for now

Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year. Read more »

California teaming: Anthem orchestrates new network venture

Call it managed care 2.0. The latest idea in affordable networks is bringing together a large insurer and disparate providers to create a simplified, integrated care system. Read more »

Dropping out of a public exchange

What happens when an insurer with the bulk of a state's public exchange membership pulls out? Read more »

HIX verification woes may spell some chaos

Before the next open enrollment begins, verification issues are lingering for several hundred thousand consumers on existing exchange plans, leaving insurers and providers facing a range of potential problems. Read more »

A case for limited networks and rich primary care choices

Narrow networks sparked consumer angst and new government oversight after the Affordable Care Act's first open enrollment period. But now, there's evidence that limited networks can be a win-win, albeit with one primary caveat. Read more »

The regional, private HIX takes off

In the latest development of private health insurance exchanges, one large Blue Cross company is betting on the single-carrier model as a way to keep group business, or hopefully expand it. Read more »

Blues benefit from technology venture

A joint investment in a health IT company by two Blue Cross companies and a private equity firm is reaping a few billion amid healthcare's tech boom. Read more »

WellPoint brings ACO strategies to commercial, Medicaid members

Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies. Read more »

Proton center growth spurs need for payer efficacy studies

As proton cancer treatment centers expand, payers and providers may have to collaborate to expand the evidence base, to avoid the highly-expensive technology crowding out other investments. Read more »

Insurer expands ACO with physician group

Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York. Read more »

CareFirst nabs CMS ACA guru

A former Medicare administrator who helped nurture many of the Affordable Care Act's new Medicare regulations is bringing his experience to the private sector. Read more »

Following consumer sentiment, Cigna invests in new brand

In branding, sometimes it's worth giving up old ideas and trying new ones, or at least transitioning to new messages when it seems they're not resonating. Read more »

Market share, pricing come to a head in HIXs

What happens when the insurers who flooded exchanges and garnered the bulk of the membership increase their rates? Read more »

Targeting readmissions regionally

Health reform is creating a new impetus for regional payers and providers to collaborate on long-standing problems. Medicare is proving to be a good place to start. Read more »

UnitedHealth Group data firm expands influence

UnitedHealth Group's big data venture is plying new waters in deals with several powerful healthcare institutions, trying to create value with one of healthcare's largest databases. Read more »

ACO ideas to borrow from the rest of the world

For the many health organizations trying out or diving into accountable care, there are some important ideas from abroad to consider during the next stages of design and evaluation. Read more »

Movement builds to curtail duals expansion

Healthcare advocates for seniors are trying to stop a managed care expansion for the country's largest Medicare-Medicaid dual eligible population, in what could be a precedent for other states. Read more »


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