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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 »

To innovate for consumers, insurers must nurture culture, data


If health insurers want to garner new members and keep them well, it may be worth looking internally, at how employees are faring and how managers make decisions. Read more »

Private exchanges grow quickly, but challenges loom


An estimated three million people currently receive employer health benefits through a private exchange, according to new report released Thursday at AHIP Institute 2014. Read more »

How to start bringing down specialty drug costs


Sovaldi has brought high prices of specialty drugs to the fore. Less examined so far are proactive approaches insurers and drug benefits managers can use to curb the growth trend without sacrificing quality or access. Read more »

Going out on a limb for health plan product design


Insurers selling public exchange plans last year faced a lot of uncertainty. This year it's a bit better, but the plans remain a product design experiment with confounding variables in an environment much in flux. Read more »

Value-based reimbursement coming, but not without challenges


The value-based reimbursement model predicted by many to dominate the reimbursement market is also the one they say will be hardest to implement. Read more »

Three state health insurance exchanges offer crucial lessons


If your state is building a health insurance exchange, or you hope it ultimately will, the experience of Washington, Kentucky and Minnesota can help. Read more »

ACA catastrophic plans go on the offensive


To some, many of the new bronze-level health plans sold in public exchanges are de facto catastrophic plans. Others say, "Not so," as young people especially need more low-premium plans. Read more »

To engage members, health plans must first win trust


In the new era of individual consumer-based health insurance, insurers have to earn the trust of Americans if they want to address the costly chronic disease burden. Read more »

Private ACOs gain momentum


While Medicare's ACOs have had mixed early outcomes, some young commercial accountable care ventures, including PPO plans, are showing promise. Read more »

Catastrophic payouts soaring


The boom in employer self-funding is coming along with many more catastrophic claims, raising concerns for insurers bundling third-party administrative services and stop-loss coverage. Read more »

To improve hospitals, give consumers data


States are making a bold move toward healthcare transparency, betting that easily-available hospital data will empower consumers and drive quality changes. Read more »

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