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HMO, PPO, EPO: What health plan is best?

What's in a name? When it comes to health plans sold on the individual market, these days it's often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you're buying by name alone -- assuming you're one of the few people who know what an EPO is in the first place. Read more »

Copper ACA plans proposed to meet healthy demand

The idea of a new "copper" tier of health plans is being pitched for the most healthy and cost-conscious consumers. Read more »

Network un-narrowing: Top hospital wins over HIX plans

One of the most acrimonious disputes of the insurance exchange debut is coming to a close, in a testament to the market influence some providers now have. Read more »

Movement grows for Medicaid-covered transgender therapies

Oregon is mandating Medicaid coverage for gender dysphoria treatment, bringing it in parity with the state's progressive commercial market and also putting pressure on other states and insurers. Read more »

States step in to regulate drug copays

Insurers may need to find new ways to control costs for specialty drugs, as more states add limits to cost-sharing and utilization continues to grow. Read more »

The end of the mega hospital?

From a real estate perspective, the healthcare landscape is dramatically changing. The massive, monolithic structures that have come to represent the acute care setting are becoming more stratified in smaller buildings across wider swaths of a community. Read more »

Medicare Advantage lets hospitals dip toes into insurance

Among providers trying to get into the insurance game, some are starting off small at the local level, but in a big, growing market segment. Read more »

Disruption of diagnostics may be boon for payers

The way blood-based diagnostic tests are performed and paid for could change dramatically if a new company has its way, with the potential to benefit patients and payers at the expense of traditional providers. Read more »

Exchange network regulations stir concern

In the debate over provider networks, broad access has been the goal of many patient advocates, but some are also warning of unintended consequences of over-regulation. Read more »

Temporary growth may cloud reform realities

The Affordable Care Act is boosting short-term finances for insurers and providers alike. Long-term, though, traditional business models appear untenable and health organizations must evolve to remain sustainable. Read more »

Drug price spikes forebode consumer, health plan dangers

A once-promised truth in pharmaceutical benefits management is unravelling, leaving payers exposed and researchers scratching their heads. Read more »

Payer telemedicine expansions raise new opportunities

Long heralded by technologists, telemedicine is increasingly in demand from consumers. But as insurers warm to reimbursing the service, challenges loom in attaining healthy return on investments. Read more »

WellPoint rebranding

In the new health insurance economy, where individual consumers have more and more choices, a health plan's brand is one of its biggest asset. Sometimes it has to be changed. Read more »

Entrepreneurs set sights on self-insured market

As more companies migrate to self-funding, insurers are trying to meet demand with better outsourced management and new stop loss products. But a few startups with radical ideas are trying to beat them, offering new services to capitalize on frustration with the status quo. Read more »

Preferred network access in Part D under dispute

Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D. Read more »

Health systems have a go at Medicaid managed care plans

Of all the health organizations working as Medicaid managed care plans, a good number of provider-based plans are thriving, sometimes in places where traditional Medicaid HMOs are not. Read more »

Legacy pricing allegations end with record settlement

Along with the changes and new costs coming with health reform, past problems are cropping up for some insurers, even setting regulatory records. Read more »

As wellness market booms, challenges emerge

The employer wellness movement is gaining steam globally, but some trends are hitting a wall. Read more »

Claims data a key to changing avoidable ER visits

One state is finding new approaches to managing Medicaid frequent fliers. Read more »

Crackdown may be coming for Medicare Advantage

Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come. Read more »

More insurers see case for telemedicine

Pretty soon, 24/7 digital access to a physician or nurse practitioner could be a standard health plan benefit. Read more »

Retail healthcare 2.0: A 'new retail price'

Walmart is taking another, bigger step into American healthcare with new primary care services. Is a health plan next? Read more »

Medicaid plans see need for value-based diabetes care

The diabetes crisis and pay-for-value evolution are coming to a head, helping change provider reimbursement in Medicaid. Read more »

In data security, compliance is not everything

There's been a lot of talk about compliance lately. Federal and state regulations. HIPAA regulations. But, if you're in charge of healthcare security, compliance is far from sufficient, according to one large insurer. Read more »

High-value providers beget more competition, payer pilot suggests

Access to prices and just a bit of nudging seems to not only help members find the best deals on elective health services like imaging but also spur some competition among providers. Read more »

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