All news headlines

A case for limited networks and rich primary care choices

Narrow networks sparked consumer angst and new government oversight after the Affordable Care Act's first open enrollment period. But now, there's evidence that limited networks can be a win-win, albeit with one primary caveat. Read more »

The regional, private HIX takes off

In the latest development of private health insurance exchanges, one large Blue Cross company is betting on the single-carrier model as a way to keep group business, or hopefully expand it. Read more »

Blues benefit from technology venture

A joint investment in a health IT company by two Blue Cross companies and a private equity firm is reaping a few billion amid healthcare's tech boom. Read more »

WellPoint brings ACO strategies to commercial, Medicaid members

Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies. Read more »

Proton center growth spurs need for payer efficacy studies

As proton cancer treatment centers expand, payers and providers may have to collaborate to expand the evidence base, to avoid the highly-expensive technology crowding out other investments. Read more »

Insurer expands ACO with physician group

Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York. Read more »

CareFirst nabs CMS ACA guru

A former Medicare administrator who helped nurture many of the Affordable Care Act's new Medicare regulations is bringing his experience to the private sector. Read more »

Following consumer sentiment, Cigna invests in new brand

In branding, sometimes it's worth giving up old ideas and trying new ones, or at least transitioning to new messages when it seems they're not resonating. Read more »

Market share, pricing come to a head in HIXs

What happens when the insurers who flooded exchanges and garnered the bulk of the membership increase their rates? Read more »

Targeting readmissions regionally

Health reform is creating a new impetus for regional payers and providers to collaborate on long-standing problems. Medicare is proving to be a good place to start. Read more »

UnitedHealth Group data firm expands influence

UnitedHealth Group's big data venture is plying new waters in deals with several powerful healthcare institutions, trying to create value with one of healthcare's largest databases. Read more »

ACO ideas to borrow from the rest of the world

For the many health organizations trying out or diving into accountable care, there are some important ideas from abroad to consider during the next stages of design and evaluation. Read more »

Movement builds to curtail duals expansion

Healthcare advocates for seniors are trying to stop a managed care expansion for the country's largest Medicare-Medicaid dual eligible population, in what could be a precedent for other states. Read more »

The challenge of enrolling rural members

Americans living in rural areas will be a key target as insurers, states and nonprofit groups strategize how to enroll more people in exchange plans this fall. Read more »

Payers can benefit from healthcare consumerization

The currents of health reform and consumerization are getting more treacherous for incumbent hospital businesses, but payers and retailers, especially, have waves to ride. Read more »

Aetna marches on with ACOs

Aetna's ACO portfolio keeps growing, as the insurer tries to capitalize on Medicare Advantage rate pressure and step in where some competitors face upheaval. Read more »

In HIX year two, affordability a key focus

Many insurers setting premiums for the upcoming exchange season seem to be banking on consumer price sensitivity. Some are also poised to draw the most cost-conscious enrollees away from competitors. Read more »

Highmark takes on outpatient markups

Highmark, an insurer with its own health system, is challenging a growing and controversial billing practice that also happens to be a central part of some health system integration strategies. Read more »

PBMs fight new payment, trade secret regulations

The pharmacy benefits industry is challenging a new state law, trying to protect a key management tool that insurers, employer groups and public payers have been relying on for cost stability. Read more »

When consumers have 'no concept of insurance'

Signing people up for health insurance is the easy part of Rawha Abouarabi's job ministering to immigrants and Arab Americans in this manufacturing hub along the Rouge River in Dearborn, Michigan. Read more »

Cost conundrums persist in land of expensive medicine

For a state trying to get a handle on notoriously high healthcare spending, there are some reasons to be cautiously optimistic and keep following those with the most market power. Read more »

ERISA turns 40, group insurance in flux

Forty years after the creation of a national regulatory framework for workplace benefits at large employers, employee health benefits are in the midst of another evolution. Read more »

Pennsylvania relies on private option, managed care in Medicaid expansion

Another state is being offered a federal waiver to expand Medicaid on its own terms, hoping to bring the efficiency of private insurance and new value incentives to the public payer program. Read more »

Population health solutions lagging

Healthcare organizations are struggling to get a handle on population health and find the necessary data management tools. Read more »

New impetus for tackling the lifestyle conundrum

Payers that want to help their members avoid the worst and most expensive experiences with cardiovascular disease now have more evidence and options. Read more »

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