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Seniors pass on Medicare obesity help


In the farming town of Exeter, deep in California's Central Valley, Anne Roberson walks a quarter mile each day to her mailbox. Her walk and housekeeping chores are the 68-year-old's only exercise, and her weight has remained stubbornly over 200 pounds for some time. Read more »

Medicaid programs struggle to meet dental demand


When Pavel Poliakov's small clothing shop in a picturesque college town closed last year, he felt lucky to be able to sign up for Medicaid just as Colorado expanded the program under the new healthcare law. Read more »

Catholic hospital giant buying small health plan


The nation's largest nonprofit health system is quietly getting into the insurance game under the auspices of population health. Read more »

Medicare Advantage 2016 rate season begins


Medicare Advantage reimbursement and regulatory changes are coming, along with new probes into risk adjustment practices that could lead to settlements and clawbacks. Read more »

With tax woes, special enrollment extends shopping


The federal government is extending the exchange sign-up deadline, due to concerns about tax season confusion and subsidy mistakes for some 800,000 Americans. Read more »

Health reform losses for smaller for-profit insurer


While the new health insurance market is about as profitable as the pre-reform era for some large insurers, that is not the case for those like Assurant. Read more »

South Carolina Blues well capitalized, diversified


South Carolina might be an unlikely place from which to run a small healthcare empire, but the state's oldest health insurance company is doing just that. Read more »

Why the wellness model must evolve anew


Corporate wellness skeptics are out early this year, arguing that the data is squarely on their side and that simpler, laissez faire approaches could be more effective. Read more »

Skirmish over PPO access, charges leads to lawsuit


Once again, insurance practices on cost-sharing and reimbursement for out-of-network providers and PPOs are ending up in dispute, with backlash from providers and customers. Read more »

Boeing's ACO-esque plans taking flight


Workers at Seattle's largest employer are signing up in droves for new ACO health plans led by regional health systems, who see the model as ripe for growth. Read more »

Pressure mounts to overhaul military health plans


The U.S. Department of Defense can look like a benefits company "that occasionally kills a terrorist." The agency has to overhaul its healthcare contracting, especially TRICARE, according to advocates. Read more »

UHG upgrades mobile app, looks to food rewards


The nation's largest insurer is making leaps in the journey of consumer-driven healthcare, improving its digital offerings and investing in new member incentives. Read more »

Figuring out if a doctor is in network harder than it should be


"Is this doctor in my insurance network?" is part of the litany of questions asked when considering whether to see a particular doctor. Unfortunately, the answer may not be a simple yes or no. Read more »

Will transparency make certificate of need moot?


After decades of research showing at best mixed benefits, certificate of need programs are starting to look antiquated and deleterious in the age of consumer-driven healthcare. Read more »

With or without co-ops, insurance to follow consumers


Whether or not more co-ops falter, many insurers could learn from some of their goals and experiments, including in primary care. Read more »

Love for health reform and its discontents


After a weekend of Merlot, brie, oysters and chocolate (and maybe more snow), a sampling of the most prolific prose from an annual healthcare tradition: health policy valentines.

CMS calls on insurers to improve cancer care with Medicare


Medicare is looking for commercial insurance partners to join a multi-payer, physician-led effort aimed at "transforming" oncology and helping financing become more sustainable. Read more »

Fertile individual market lets brokers avoid extinction


The predicted demise of health insurance brokers may have been premature. Industry veterans and entrepreneurs are carving out niches and expanding their roles in the new market. Read more »

HIX auto-enrollment turbulence on the way


Changes in open enrollments to come and evolving state and federal policies promise new uncertainties for insurers trying to soundly price their plans and retain membership. Read more »

Anthem hack spurs momentum for data protection regulation


In the wake of Anthem's massive data breach, a storm of class action lawsuits are raising concerns about information protection, liability and regulation. Read more »

Rite Aid jumps into PBM game


The country's fourth largest drugstore chain is making a $2 billion bet on the business of pharmaceutical benefits management, amid rising drug prices and demand for retail consumer healthcare. Read more »

VC-backed startup insurer sets sights on expansion


One of the most ambitious startup insurers, a self-described "better kind of insurance company," may soon start selling in some of the nation's largest markets, including the world's technology capital. Read more »

Uncertain prognosis for co-ops


How many more ACA cooperative insurers will go out of business? At least some are going to be hard pressed. Read more »

HIX data integrity still lacking


As the ACA's second open enrollment period closes, many health plans are likely to find themselves in the midst of a lot of data analysis and submission work, to ensure a good consumer experience and fair deals from the 3Rs. Read more »

Texas Blues, independent docs saddle up for accountable care


The southwest's largest Blue Cross insurer is hoping to find value by working with independent physicians and the state medical association, as powerful health systems loom in the field of ACOs. Read more »

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