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Blues on the market for a new CEO

Wanted: A chief executive to lead a 76-year-old insurance company through a jungle of regulatory challenges, legacy business upheaval and new competition. Read more »

Pennsylvania health system collaborative taps dominant insurer

Clinical integration and accountable care developments in greater Philadelphia are taking a novel turn, with one large insurer teaming up with a new multi-health system collaboration. Read more »

Medicaid under mandate to cover autism treatment

The federal government is ordering state Medicaid programs to pay for comprehensive autism services, but some details remain unclear. Read more »

Cancer study lends support to outpatient focus

As payers continue to look for the best ways to cover cancer treatment, a new study is lending support to the argument for moving away from hospital inpatient settings. Read more »

Federal marketplace gets new CEO

An insurance industry veteran who managed one of the few well-functioning state exchanges in the first open enrollment period is taking a key federal post. Read more »

Insurer, health system clash at crossroads

A regional payer-provider dispute over costs and value is showing that troubles can arise amid efforts to design reforms and move away from fee-for-service. Read more »

Aetna to recoup $8.4M for inflated ER billing

While more payers and providers are trying to pursue value-based reimbursement models, some insurers are finding themselves fighting back against questionable fee-for-service schemes. Read more »

Lawsuit a test for wellness program limits

The federal government's employee advocate is trying to draw a line in the sand for wellness programs, and raising questions about the value and legality of some employers' incentive-based cost containment strategies. Read more »

Some insurers refuse to cover contraceptives, despite ACA requirement

How much leeway do employers and insurers have in deciding whether they'll cover contraceptives without charge and in determining which methods make the cut? Not much, as it turns out, but that hasn't stopped some from trying. Read more »

Michigan Blue's quality efforts save millions

Over a five-year period, five programs sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network to improve the quality of certain medical and surgical procedures performed in Michigan hospitals, have produced $597 million in healthcare cost savings, and have lowered complication and mortality rates for thousands of patients. Read more »

HMO, PPO, EPO: What health plan is best?

What's in a name? When it comes to health plans sold on the individual market, these days it's often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you're buying by name alone -- assuming you're one of the few people who know what an EPO is in the first place. Read more »

Copper ACA plans proposed to meet healthy demand

The idea of a new "copper" tier of health plans is being pitched for the most healthy and cost-conscious consumers. Read more »

Network un-narrowing: Top hospital wins over HIX plans

One of the most acrimonious disputes of the insurance exchange debut is coming to a close, in a testament to the market influence some providers now have. Read more »

Movement grows for Medicaid-covered transgender therapies

Oregon is mandating Medicaid coverage for gender dysphoria treatment, bringing it in parity with the state's progressive commercial market and also putting pressure on other states and insurers. Read more »

States step in to regulate drug copays

Insurers may need to find new ways to control costs for specialty drugs, as more states add limits to cost-sharing and utilization continues to grow. Read more »

The end of the mega hospital?

From a real estate perspective, the healthcare landscape is dramatically changing. The massive, monolithic structures that have come to represent the acute care setting are becoming more stratified in smaller buildings across wider swaths of a community. Read more »

Medicare Advantage lets hospitals dip toes into insurance

Among providers trying to get into the insurance game, some are starting off small at the local level, but in a big, growing market segment. Read more »

Disruption of diagnostics may be boon for payers

The way blood-based diagnostic tests are performed and paid for could change dramatically if a new company has its way, with the potential to benefit patients and payers at the expense of traditional providers. Read more »

Exchange network regulations stir concern

In the debate over provider networks, broad access has been the goal of many patient advocates, but some are also warning of unintended consequences of over-regulation. Read more »

Temporary growth may cloud reform realities

The Affordable Care Act is boosting short-term finances for insurers and providers alike. Long-term, though, traditional business models appear untenable and health organizations must evolve to remain sustainable. Read more »

Drug price spikes forebode consumer, health plan dangers

A once-promised truth in pharmaceutical benefits management is unravelling, leaving payers exposed and researchers scratching their heads. Read more »

Payer telemedicine expansions raise new opportunities

Long heralded by technologists, telemedicine is increasingly in demand from consumers. But as insurers warm to reimbursing the service, challenges loom in attaining healthy return on investments. Read more »

WellPoint rebranding

In the new health insurance economy, where individual consumers have more and more choices, a health plan's brand is one of its biggest asset. Sometimes it has to be changed. Read more »

Entrepreneurs set sights on self-insured market

As more companies migrate to self-funding, insurers are trying to meet demand with better outsourced management and new stop loss products. But a few startups with radical ideas are trying to beat them, offering new services to capitalize on frustration with the status quo. Read more »

Preferred network access in Part D under dispute

Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D. Read more »


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