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Payers need personalization, new tech to stay relevant


The traditional health insurance business model is on the verge of a cataclysmic shift toward individual consumers. While that will require moving away from the old IT running within many payers, it also makes now a great time for reinvention, venture capitalists argue, if not the only opportunity. Read more »

A patch for the painkiller cost crisis: dependence treatment


Health insurer spending on treatment for painkiller dependence is on the rise, and proving to be one of several tools needed to curb the epidemic of opioid addiction. Read more »

Can payment reform evolve while shared-risk lags?


Health insurers are betting on value-based payments, broadly defined, but providers still seem skittish. Read more »

Payers are prepared, others not so much


Don't rule out chaos for next year's ICD-10 deadline, or maybe plan on it, if the latest readiness research is any indication.  Read more »

Aetna reaps big from IT startup bets


Rethinking how it acquires information technologies seems to be giving one insurer an edge, letting it eke out a "trifecta" of lower costs, fewer unhappy customers, and increased revenue. Read more »

'Any willing provider' idea emerges in new battle


Network adequacy concerns are starting to generate renewed interest in new health plan provider mandates. Read more »

Of ICD-10 and 'Game of Thrones'


The parallels between the nation's ICD-10 switch and the popular fantasy epic are real. Read more »

Demanding more evidence from diagnostics


Advances in molecular and genomic technology are creating a maze of new options for payers and patients replete with quite a few meaningful improvements as well as some dead ends. Read more »

Medicaid enrollment, policy challenges keep growing


The ranks of Medicaid are reaching record levels, giving payers and providers, especially, new opportunities. Read more »

HIX network lawsuits keep coming


The backlash against narrow networks continues, as more displeased individual health consumers take their grievances to the courts of law and public opinion. Read more »

Bundled payments hit a snag


In bundled payments, where once there was so much promise, there is now conflicting evidence. Read more »

Cancer crisis turns insurers into venture investors


The stakes for improvement and innovation are high in American cancer care, and insurers are trying to wield some of their influence to get a return on investment for their members and their budgets. Read more »

ACA rate review slows premium growth, not participation


The Affordable Care Act's rate review is turning out well for consumers, according to the federal government, and although insurers may not be stoked about the new administrative work, it doesn't seem to be scaring them away. Read more »

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 »

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