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Clinic network with a health plan looks to upend entrenched system


In the Pacific Northwest, a new kind of health system, "with insurance built in," is trying to validate its primary care model and disrupt a seemingly competitive regional healthcare market. Read more »

How much does it cost to have a baby?


Which hospital parents pick to deliver their baby can have serious cost consequences, according to a new study. Read more »

A model for helping consumers avoid surprise out-of-network charges


It's a situation that occurs all too often: Someone goes to the emergency room and doesn't learn until he gets a hefty bill that one of the doctors who treated him wasn't in his insurance network. Read more »

6 million pay ACA fine rather than pay health insurance companies


More Americans than expected opted out of the individual insurance mandate, including some who didn't even have to. Read more »

Theranos, AmeriHealth try to bring affordable diagnostics to Medicaid


The latest deal by diagnostics company Theranos suggests that the old school and new school can collaborate, and that the Blues might have a little something up their sleeves. Read more »

Marilyn Tavenner lands as AHIP chief


Instead of retiring, Marilyn Tavenner, the former nurse, hospital executive and Medicare administrator, is going to represent the economic and political interests of American health insurers. Read more »

Pharma payment a day keeps docs' finances okay


Few days went by last year when New Hampshire nephrologist Ana Stankovic didn't receive a payment from a drug company. Read more »

Maryland revamps in vitro coverage mandate for same-sex couples


Maryland same-sex couples who wanted to take advantage of a state law that requires insurers to cover pricey in vitro fertilization treatments used to face insurmountable obstacles. Not anymore. Read more »

Oncologist who ran 'chemo mill,' pushing unneeded treatment, gets 45 years


A Michigan hematologist will likely spend the rest of his life in prison after defrauding Medicare and private insurers, and violating the first tenet of medicine, "Do no harm." Read more »

North Dakota Blues back in the black


North Dakota’s largest health insurer has made a quick turnaround after a year of underwriting losses and lost technology contracts. Read more »

Reducing costs through high-value referral networks


James Colbert, MD, Harvard medical instructor and ACO Learning Network consultant, on the challenges and opportunities of designing high value networks and the data needed to do it. Read more »

Birth control coverage saves women significant money


Women are saving a lot of money as a result of a health law requirement that insurance cover most forms of prescription contraceptives with no additional out-of-pocket costs. But the amount of those savings and the speed with which those savings occurred surprised researchers. Read more »

Deal Flow: Theranos takes diagnostics disruption effort to the East Coast


Trying to bring affordable, painless lab tests to the masses, Theranos is breaking into a new market in collaboration with one of Pennsylvania’s major insurers. Read more »

340B probe raises hospital incentive concerns


Not only are many hospitals getting sizable federal drug discounts, some may be over-prescribing, according to the Government Accountability Office. Read more »

Revealed audit stings Blue Shield of California's image


The case against Blue Shield of California’s tax-exempt status is growing, presenting an additional $40 million to the tax bill, but also the possibility of more drastic state action. Read more »

Double Digits: Who’s had affordable exchange premiums?


While individual premium proposals for 2016 are still pending, data from the ACA exchange markets offer a backdrop to next year’s double digit increases. Read more »

In largest-ever insurance deal, Aetna buys Humana


An old Yankee insurance company is taking over the younger, Louisville-based Humana. It’s a deep dive into Medicare, government-funded health plans and new ways of delivering and paying for healthcare. Read more »

Docs order fewer preventive services for Medicaid patients?


Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found. Read more »

Supreme Court's decision likely to impact health insurers as spouses join plans


The right to marry in any state won't be the only gain for gay couples from last week's Supreme Court ruling. The decision will probably boost health insurance among gay couples as same-sex spouses get access to employer plans, say analysts and benefits consultants. Read more »

Subsidies okay in federal marketplace, high court rules


The U.S. Supreme Court has dismissed the challenge to the Affordable Care Act's subsidies in federally-facilitated exchanges, a victory for the Obama Administration but certainly not the last health reform battle. Read more »

Blues 'cartel' battle casts doubt on Anthem deal and more


The Blues have been accused of running health insurance like a mafia for years, but now lawsuits could stick and compromise the family's future. Read more »

Millennials want to work in health insurance?


Despite looming consolidation, health plans and insurers broadly need to attract more younger workers as Baby Boomers retire and markets evolve. Read more »

UnitedHealth Group leaving AHIP


There will soon be one less member company of America's health insurance trade group, a sign of the industry's evolutionary turmoil. Read more »

Covered California turns to big data


The country's largest state insurance exchange wants to be an active purchaser negotiating on behalf of consumer, and a data-driven convener of affordability and quality. Read more »

Insurers ordered to increase, yes increase, premiums


Oregon's top health insurance regulator is taking the unusual step of encouraging higher premiums in a competitive individual market, where the lowest-cost plan may also be the most disruptive. Read more »

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