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ACA tax consequences loom over Medicaid

With a new fiscal year approaching in many states, a big financial cloud is hanging over Medicaid managed care organizations: the Affordable Care Act's insurance fee. Read more »

How to do software modernization right

Modernizing code is essential for payers as technology ages and healthcare evolves. How does it work, and what's on the line? Read more »

Midwestern co-op tries to reinvent nonprofit health insurance

Of the 24 federally-supported cooperative insurers, one is off to a somewhat disruptive start in the Blue Cross-dominated insurance markets of Iowa and Nebraska. Read more »

Sour provider relationships for some payers, though not for all

Their rates may be somewhat low, but Blues plans tend to pay on time and can be trusted, a survey of health system executives found. Not so for other large insurers. Read more »

Repeal of employer mandate could shake up group insurance

Amid strong lobbying by business groups, support is growing to end the Affordable Care Act's employer mandate, a change that would see millions more Americans buying their health insurance through exchanges. Read more »

For-profit hospitals optimistic after Q1

Increased admissions drove revenue gains for Tenet Healthcare Corporation and Community Health Systems in the first quarter of 2014 compared to 2013. Both for-profit hospital firms appear confident midway through Q2. Read more »

HHS nominee defends ACA to lawmakers

Despite HHS Secretary nominee Sylvia Mathews Burwell getting asked some hard-line questions from lawmakers at a Senate hearing, she did receive overwhelming bipartisan support. Read more »

Health giants' reimbursement dispute starts disrupting regional market

If the contract between Highmark and UPMC expires in six months, western Pennsylvania may become a case study for what some think is the future of American healthcare — consolidated integrated delivery networks. Read more »

A movement builds to revamp rules for HSA plans

Amid the rise of high-deductible health plans and the growing prevalence and burden of chronic diseases, some argue that it may time to rethink the concept and regulation of preventive services. Read more »

First quarter brings focus to individual market

Once a business on the fringes, the individual insurance market is getting more focus from large insurers like Humana and Health Net. Read more »

Public outcry prompts rating area redesign

After an uproar from consumers facing the highest premiums in the nation, Colorado's insurance commissioner is offering to revamp the geographic rating system and to implement it lickity-split. Read more »

Heavy losses cost Blues CEO his job

Despite a booming state economy, Blue Cross and Blue Shield of North Dakota is booking huge losses, with more potentially to come from a botched contract, leaving the board looking for fresh leadership to bring a turnaround. Read more »

To bend the cost curve, first figure out the costs

The University of Pittsburgh Medical Center is hoping a cost-analysis system from their Italian transplant hospital will become the future of cost measurement here in the United States. Read more »

Courting payers with a new health system model

Amid the many mergers and acquisitions sweeping through healthcare, some raising the ire of anti-trust regulators, four health systems in greater Philadelphia are taking a different tack in a bid to integrate care and lure new insurance contracts. Read more »

High deductibles give new life to supplemental plans

With more employers adopting high deductible plans for their workers, the market is opening up for supplemental benefits in some of healthcare's most expensive areas. Read more »

Growing pains for Medicaid managed care expansions

Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans. Read more »

How many of the new HIX enrollees were uninsured?

More than 8 million Americans selected health plans in public exchanges during the Affordable Care Act's first enrollment period. But how many of them were previously uninsured? And does it matter? Read more »

Unintended consequences of ICD-10 delay cast pall on outlook

Mothballing, busted budgets and a lack of credibility are swirling in the minds of ICD-10 managers, and it's enough to make some insurers question the logic of future investments. Read more »

Cigna unphased by early HIX members' claims

Cigna is hoping to sustain positive first quarter results for the rest of the year,  in part relying on expanding collaborative care initiatives, as new exchange members turn out to be surprisingly high utilizers. Read more »

State cracks down on predatory loans for tummy tucks

New York's attorney general has fired what he hopes will be a warning shot at the industry of loan brokers and lenders targeting consumers who want to pay for elective procedures. Read more »

Fresh with new HIX members, WellPoint starts year upbeat

After the first open enrollment period, WellPoint executives are confident that public exchanges will be profitable and that they won't be bailing anybody out. Other areas, they're not so sure about, despite better than expected first quarter results. Read more »

Is payer-provider convergence inevitable?

With at least 15 percent of Americans now covered through an accountable care organization of some sort, integration seems almost inexorable. But not all is well in the land of Medicare ACOs, and in the private sector, the evolution may hit a few dead ends. Read more »

Hospital drug discounts in crosshairs

A recent analysis of the federal government's 340B drug discount program suggests that eligibility is too broad and that lawmakers need to tighten it, which may mean that hundreds of hospitals currently in the program would be booted out. Read more »

Medicaid plans seek solutions for Sovaldi dilemma

Growing more anxious about the impact of the expensive new hepatitis C drug Sovaldi and the routes states may take, Medicaid managed care organizations are looking for help. Read more »

Social media undervalued in customer service

How do consumers want to talk to their health plans? By any means possible, please, and right now. Read more »


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