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Going out on a limb for health plan product design


Insurers selling public exchange plans last year faced a lot of uncertainty. This year it's a bit better, but the plans remain a product design experiment with confounding variables in an environment much in flux. Read more »

Value-based reimbursement coming, but not without challenges


The value-based reimbursement model predicted by many to dominate the reimbursement market is also the one they say will be hardest to implement. Read more »

Three state health insurance exchanges offer crucial lessons


If your state is building a health insurance exchange, or you hope it ultimately will, the experience of Washington, Kentucky and Minnesota can help. Read more »

ACA catastrophic plans go on the offensive


To some, many of the new bronze-level health plans sold in public exchanges are de facto catastrophic plans. Others say, "Not so," as young people especially need more low-premium plans. Read more »

To engage members, health plans must first win trust


In the new era of individual consumer-based health insurance, insurers have to earn the trust of Americans if they want to address the costly chronic disease burden. Read more »

Private ACOs gain momentum


While Medicare's ACOs have had mixed early outcomes, some young commercial accountable care ventures, including PPO plans, are showing promise. Read more »

Catastrophic payouts soaring


The boom in employer self-funding is coming along with many more catastrophic claims, raising concerns for insurers bundling third-party administrative services and stop-loss coverage. Read more »

To improve hospitals, give consumers data


States are making a bold move toward healthcare transparency, betting that easily-available hospital data will empower consumers and drive quality changes. Read more »

Let's talk about death: Key issues in palliative care


As new generations age, with some 10,000 Americans expected to turn 65 every day over the next 15 years, the ability to extend life is increasing. But a logistical conversation about death is one that families, couples and policymakers can't avoid. Read more »

Who's going to be the Trader Joe's of healthcare?


Much-loved by a key consumer demographic and highly-guarded by its corporate parent, Trader Joe's has pioneered affordable, great quality groceries. Can its model work in America's healthcare system? Read more »

Medicaid expansion helps smooth out turmoil


As Medicaid enrollment grows to record levels, covering 65 million people nationwide, providers are starting to see some positive trends in their rates of uncompensated care, as managed care organizations garner new membership. Read more »

Medicaid financing in a bind, state ponders ACO


As a once-promising tax scheme to maximize federal Medicaid dollars fades from practicality, budget woes are coming to the fore and creating an impetus for program redesigns. Read more »

New Hampshire's managed care program loses key health plan


Not one year into New Hampshire's Medicaid managed care expansion, one physician-operated health plan is deciding to redirect its resources elsewhere, leaving other plans with new responsibilities. Read more »

Florida Blue grows accountable care network


Florida's largest insurer is humming along with its strategy of alternative reimbursement models, signing an accountable care agreement with one of Tenet's ACO networks. Read more »

State HIX competition grows


Many residents in New England are going to have more choices in the public exchanges this fall, as some insurers' growth strategies are tested. Read more »

Startups come after HR, broker business


For employees, there can be nothing quite like the paperwork of HR and benefits, and for employers it can be expensive, especially with new ACA reporting requirements. Internet companies are trying to cash in on that, and could also shake up the insurance broker business. Read more »

Insurer seeks payout for troubled spine product


Amid new skepticism of back pain treatments, one of the largest medical device makers is being sued for a product that brought in close to one billion dollars annually at its peak while increasing risks for patients. Read more »

Medicaid MCO tax scheme under fire


The practice of taxing Medicaid managed care organizations to raise revenue for state-share payments has left some auditors scratching their heads, raising questions that could shake up financing models. Read more »

On the lookout for HIX fraud


Among all of the public money that federal healthcare watchdogs are trying to follow is a lot that will continue to be devoted to marketplaces and tax credits. Read more »

The trouble with narrow networks


Around the country, narrow provider networks are sparking consumer backlashes, prompting regulatory intervention and also raising questions about the value of current insurance designs. Read more »

The end of group insurance?


Health insurers' most profitable book of business may be on the way out. If the projections of Fortune 500 companies are to be believed, the next half-decade will be sink-or-swim to the other end of evolving exchange markets. Read more »

The best and worst payers, from the eyes of medical practices


The annual PayerView Report, from health IT company athenahealth, reveals the healthcare payer that has the best relationship with providers and the one that has the most problems. Read more »

Medicare Advantage records sought in overpayment probes


Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies. Read more »

Doc-led ACOs show promise for patients, payers


In the search for meaningful patient care improvements and sustainable financing, some independent physician groups are charting unique approaches that may offer models for payers and providers in the age of cost-containment and risk-sharing. Read more »

Autism coverage grows, with lawsuits, mandates and voluntary changes


States, insurers and self-funded employers are facing mounting pressure to expand autism coverage, but some may be too slow for advocates. Read more »

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