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Medicare Advantage reduction pass-throughs disputed

Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans. Read more »

Readmissions equation is changing

With new incentives, hospitals are increasingly making the reduction of complications, infections and readmissions a priority, but there are still infrastructure gaps that can tangle payer-provider collaboration. Read more »

Insurer taps state HIX leader for insight

While some state exchange executives exited their exchanges amid foundering technology and low public esteem, the director of one successful state HIX has landed in the growing private exchange unit of a large national insurer. Read more »

Exchange payment concerns linger for insurers and providers

Ahead of the next open enrollment period, federal regulators are trying to clarify rules for member non-payment and grace periods, but insurers and providers may still have lingering concerns about getting paid. Read more »

Insurers still catching up with cost ratios

Americans across the country may be pleasantly surprised to get a small check from their health plans this summer, but insurers may need to plan better if they want avoid an administrative hassle. Read more »

UnitedHealthcare ups the ante on price, provider shopping

The nation's largest health insurer is making its free mobile app available to everyone, in a bid to move the needle on price transparency. Read more »

Savings accounts making way into Medicaid

If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts. Read more »

Appeals courts split on ACA's tax credit subsidies

In the latest battle of the health reform wars, four words could bring down the Affordable Care Act's main insurance expansion policy, depending on which court interpretations gain traction. Read more »

Direct care company wants to grab self-funded group biz

A direct primary care company is targeting employers with a new self-funding model that could spell disruption for the third-party administrator business. Read more »

Diabetes bundling shows prevention promise

The diabetes and obesity epidemics mean more Americans may suffer from heart disease before they turn 65, challenging payers to craft better intervention models that help prevent serious cardiovascular events and increased spending on acute care. Read more »

Errors and harm wreaking havoc

It's a chilling reality often overlooked in annual mortality statistics: Preventable medical errors persist as the number three killer in the U.S. and the source of great waste. Read more »

Another insurer exits Medicaid managed care

After taking losses of $40 million over three years, BlueCross BlueShield of Western New York is withdrawing from the Empire State's Medicaid managed care program in six of its eight counties of operations. Read more »

Insurance professionals need to use CDHPs

More and more, health insurance professionals who design consumer-driven and high deductible plans are using them personally, a trend that bodes well for their improvement. Read more »

UnitedHealth plots exchange market surge

Premiums for exchange plans in many states are set to increase anywhere from slightly to significantly, but there's new competitive pressure coming as the nation's largest insurer starts flooding markets. Read more »

Struggling Blue finds a new chief

After one of its worst years ever, one Blue Cross company is banking on an insider and native son to lead a comeback. Read more »

Pennsylvania insurer's ACO marks hospital gains

In a region dominated by one insurer and teeming with health systems, accountable care models are gaining provider acceptance but still accumulating evidence. Read more »

Provider giant primes for health plan expansion

After quietly building a small insurance unit, one of the nation's largest health systems is launching a new health plan brand that could pose more competition for established insurers. Read more »

Insurance services firm acquires HealthPocket

The healthcare tech boom continues, as one of the most-heralded consumer insurance comparison startups was acquired by an insurance services firm hungry for growth. Read more »

PBMs threaten sustainability of Medicare, Part D plans

Evidence from recent federal enforcement actions suggest pharmacy benefit managers are exposing public-payer managed care plans to problems that could send shivers up executive's spines. Read more »

Without Medicaid, hospitals may pay patient premiums

Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option. Read more »

Employers, workers migrating to HSAs

Group plans are increasingly expanding their consumer-directed health plans with health savings accounts, after toying with lower deductibles and reimbursement account wrapping. Read more »

State plan association names new executives

One of the nation's largest health insurance advocacy groups is welcoming in a new chief executive, amid a tumultuous regulatory environment. Read more »

States have options to fill Medicaid reform gaps

Amid record enrollment in Medicaid and state concerns about the program's budgetary sustainability, the federal government is offering new financial support and policy options. Read more »

Regulatory power becomes center of insurance debate

In California, insurers and regulators are fighting for control of the post-reform insurance market. Read more »

As a rule, MCR regulations not negative for insurers

With federal rules governing health plan spending looking like they're here to stay, insurers are making inroads on compliance, although they will hope for possible tweaks in the future. Read more »


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