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House passes SGR repeal with a big catch


Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on. Read more »

Blues company hit with 'historic' fine


As Montana's Blue Cross company evolves under a new corporate parent, state regulators are penalizing it for some alleged past misdeeds uncovered by an audit. Read more »

Anthem boasts high participation in value-based primary care


Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country. Read more »

Startup's IPO shows booming of healthcare transparency biz


With a banner of its logo draped over the New York Stock Exchange on the Friday before St. Patrick's Day, Castlight Health went public, in another sign that reducing friction and opacity in healthcare is sparking a gold rush of sorts. Read more »

High stakes for out-of-network containment in ERISA lawsuit


Depending on the outcome of a lawsuit Cigna is pursuing in Los Angeles, more out-of-network providers may be able to offer patients discounts while billing health plans in full. Read more »

Eligibility 'churn' presents problems for states, health plans


With researchers expecting a lot of fluctuating eligibility between Medicaid and exchange subsidies among lower-income consumers, states and insurers will have to devise new ways to solve the problem of continuity of care disruptions. Read more »

Non-compliant formularies sneak past regulators, raise value questions


The drug formularies of some small group health plans in two states don't meet essential health benefit benchmarks, a new study has found, leaving researchers pointing to a solution that may be as complex as benefit mandates. Read more »

Medicaid MCOs lag in fraud prevention


Federal healthcare auditors think Medicaid managed care organizations aren't doing enough to combat fraud and that states might have to step in with policy changes. Read more »

Health insurance exchanges gaining last-minute momentum


Through the beginning of March, 4.2 million Americans signed up for private coverage through state and federally-run exchanges, leaving federal health officials hoping for a final month's surge to meet initial projections, especially for millennials. Read more »

Aetna's latest ACO aims for shared savings


Aetna is going forward with an accountable care agreement for some 28,000 people, partnering with a health system that also has accountable care contracts with some competitors. Read more »

Amerigroup first Medicaid plan to use chip-based member record


WellPoint's Amerigroup is the first Medicaid plan in the nation to use a health record chip that enthusiasts are calling a "breakthrough health IT solution." Read more »

NCQA to overhaul health plan accreditation


The National Committee for Quality Assurance wants to modernize its health plan accreditation program with a range of new requirements that in some cases mirror trends in regulatory scrutiny. Read more »

Tavenner withdraws fractious Part D changes


Under pressure from the industry and Congress, the Centers for Medicare & Medicaid Services is withdrawing several proposed changes to the Medicare drug program, but still charging ahead with others that could prove disruptive. Read more »

CMS lays groundwork for state-run low-income plans


After a one year delay, the federal government is giving states a framework to create insurance programs for low-income residents earning above the Medicaid eligibility threshold, potentially encouraging more experimentation with public payer policies. Read more »

Ohio, Kentucky embrace innovation to get residents insured


While many states have been challenged to expand their insured populations in ways encouraged by the Affordable Care Act, Ohio and Kentucky have leveraged their distinctive political and business climates to find early success. Read more »

Humana hires retail veteran to help 'simplify' healthcare


Humana is naming a healthcare outsider as its next chief innovation officer, just as executives are looking for breakthroughs from recent acquisitions. Read more »

New provider network mandate may threaten insurance exchanges


The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's. Read more »

CMS tries to simplify ACA health plan regs, reporting rules


The federal government is once again extending pre-2014 health plans and outlining other tweaks and finalized rules for several key programs that regulators hope will smooth what continues to be a bumpy and confusing transition. Read more »

HCSC boosts capital, girds for ACA uncertainty


The parent company of some of the country's largest Blues plans appears to be shoring up cash reserves for what may one of the most unpredictable years in its history. Read more »

Private HIX market matures, but challenged to lower costs


Benefits consulting firms that made early forays into private insurance exchanges are likely to be rewarded for their prescience, although the competition is growing. Read more »

CMS sitting on unused mounds of Medicare Advantage data


The Centers for Medicare & Medicaid Services has a lot of data on Medicare Advantage plans that it should be using to inform policy and make available to the public, according to a new Inspector General report. Read more »

Aetna pilots diabetic pump therapy with Medtronic


Aetna is partnering with one of the largest medical device makers in an experiment for struggling diabetic members and their doctors. Read more »

Dual eligibles project aims to replicate state Medicaid gains


Colorado is moving ahead with an experiment for Medicare-Medicaid eligible beneficiaries, or "dual-eligibles," using a payment system many others are trying to abandon. But the state's approach incorporates a variation on the concept of the accountable care organization that's showing promise elsewhere. Read more »

Corporate wellness, wearables starting to converge


With the wellness movement reaching ever more workers, more advanced digital health and wearable technologies are going to be a necessity if the field is going to evolve and start making inroads, some argue. Read more »

Health insurance price index offers window into consumer behavior


While most of the new individual health plans are being purchased through public insurance exchanges with tax credits, many consumers are also turning to private exchanges. Read more »

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