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Changing an 'inverse correlation between cost and quality'


Behavior change is critical to better outcomes, for patients, as well as providers and payers, as one health system with an insurance arm is finding. Read more »

HIX enrollment closed, risk assignment challenges start


The Obama administration is boasting that 8 million Americans, including a good number of young people, have enrolled in public exchange plans. The big question now is how will new members fit into the risk adjustment puzzle? Read more »

WellPoint lands new strategist from one of the big three


For the first time in almost four years, WellPoint will have a chief strategy officer, just as value-based reimbursement contracts are taking off. Read more »

Industry coalition pushes for transparency


The Healthcare Financial Management Association's new Price Transparency Task Force has released recommendations for how health plans and providers should inform patients on estimated prices, out-of-pocket costs, in-network status and value. Read more »

United sees earnings fall, but more growth amid full ACA


The nation's largest insurer lead off the first financial quarter under the full Affordable Care Act with a blend of optimism for growth and pragmatism for confronting headwinds like Medicare Advantage and specialty drug costs. Read more »

Small employer market is a large opportunity


How the small employer market has a lot to gain by from private exchanges. Read more »

MCOs, health homes sought for New York Medicaid reform


New York has got a federal OK to take $8 billion in Medicaid savings to experiment with some ambitious delivery and payment reforms that build off of, but may upend, its managed care system. Read more »

Industry falling short on patient payment options


Even with some 15 million Americans covered by high-deductible health plans, health organizations are "not prepared to meet consumer payment expectations," according to the fourth annual payment trends report by InstaMed, a Philadelphia-based payment network company. Read more »

States cost-shifting on duals sparks calls for change


After finding one state shifting millions in Medicare-Medicaid dual eligible costs to the feds, Medicare's watchdog suspects more may be doing the same. Read more »

CBO projects HIX premiums, reimbursement to rise


The Congressional Budget Office has revised its estimates of the Affordable Care Act's costs, with results favorable to the Treasury. However, it also now predicts more premium and network turmoil. Read more »

Highmark's new business targets growing caregiver ranks


Highmark sees a market for guiding the millions of American adults helping their aging and ill parents, relatives and friends. Read more »

Insurers, providers try to dodge Heartbleed


When it comes to security threat severity, the Heartbleed bug doesn't miss a beat, and may not for some time. Read more »

Medicaid managed care orgs must innovate to survive


As payers on behalf of states and the federal government, Medicaid managed care organizations have the potential to drive reforms, and if they don't, they could be on the chopping block. Read more »

Some MA plans face extinction


Centers for Medicare & Medicaid Services leaders point to seniors' wide array of Medicare Advantage and Part D choices as evidence of the program's and insurer's health, but regulators may soon be terminating dozens of plans, unless sponsors pull out first. Read more »

Northwest Blues try to meet need for senior tracking


Sometimes the best solution is the simplest one. That's what some payers are finding out, for instance, with a home monitoring solution that tracks activity, rather than vital signs, for seniors and their caregivers. Read more »

Waiting for healthcare's Amazon


Many startups and companies from other industries have physicians, hospitals, insurers and medtech manufacturers in their sights, betting that they can offer better services at cheaper prices for dissatisfied consumers. Read more »

Struggling state exchange takes up shared services offer


Stuck with exchange software too flawed to fix, Maryland Health Connection leaders are choosing a novel solution that paves the way for other beleaguered state exchanges to seek help from their better performing peers. Read more »

Full-risk market slips, but some thrive


The market for commercial full-risk insurance is slowly declining amid the rise of self-insurance, but a few large nationals, the Blues and some integrated care plans are still seeing healthy business. Read more »

Pharma costs higher for exchange plan members


New public insurance exchange enrollees are starting to use their prescription drug benefits, and so far their per-member costs are looking higher than in the average commercial plan. Read more »

IBC, DaVita venture looks for new chronic care paradigm


Independence Blue Cross and DaVita HealthCare Partners are launching a new joint venture aiming to personalize, improve and ultimately reduce costs for chronic disease care in one of the country's most expensive healthcare markets. Read more »

CMS balancing act on Medicare Advantage rates


The Centers for Medicare & Medicaid Services is easing back on some of the reductions to Medicare Advantage, although the negative impact could still be as much 3 percent for some insurers and many changes loom beyond 2015. Read more »

Faith-based provider giant enters insurance biz


Competition from provider-owned health plans is increasing, with one of the country's largest national health systems scooping up an HMO in the South that could be a platform to enter other markets. Read more »

'Pay and chase' fades as insurers seek revenue integrity


With about seven percent of all public and private health insurance claims paid incorrectly, insurers have a ways to go, beyond traditional models, if the healthcare spending crisis is to be reined in. Read more »

Follow-up care may sway medication adherence


Patients don't fill first-time prescriptions nearly one-third of the time, which makes "nonadherence" an important factor working against proper disease management. Read more »

4 factors shaping higher 2015 premium prices


Health plans must calculate what they will charge for 2015 exchange plan premiums despite the lack of detailed data from the just-ended enrollment window. Rate filing deadlines are fast approaching: May for some states and June for those using the HealthCare.gov marketplace. Read more »

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