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New CEO to lead Highmark's evolution in fractious market


Highmark is changing its CEO for the third time in as many years. An executive whose work spans jewelry, fabrics and eyeglasses is taking the helm of a new integrated payer-provider in the early stages of a market war. Read more »

Sovaldi draws ideas for reigning in drug costs


The breakthrough hepatitis drug Sovaldi has sparked a vigorous debate about the financial sustainability of U.S. healthcare and the role of government in regulating prices. Read more »

ERISA skirmish may bring changes to clawback practices


A challenge to a Blue Cross company's recoupment practices has ended in victory for a group of chiropractors and with a favorable precedent for providers who want to appeal the decisions of certain health plans. Read more »

Regional insurers look for synergies without M&A


In an era of increasing consolidation, some insurers are taking a slightly different route on the health reform journey. Read more »

When a PPO isn't


Consumer concerns about new health plan networks continue, with two new members suing over a preferred provider network they say was deceitfully marketed. Read more »

Q&A: Staying HIPAA compliant at Kaiser


As a payer and provider and the country's largest managed care organization with a lot of digital and online patient data, Kaiser Permanente has tried to address privacy and security head-on, and may pave a way for others. Read more »

Cigna plows ahead with quality-based reimbursement venture


As part of a contract extension with Tenet Healthcare, Cigna has established a first of its kind quality-based reimbursement agreement. Read more »

Former managed care company leaders get time in prison


The corporate saga of a Medicaid managed care fraud case is coming to a close as three former executives head to federal prison, offering a cautionary tale for public benefits contracting. Read more »

CMS regs pave way for 2015 plans, with reinsurance tweaks


Just in time for plan application and premium rating season, federal regulators have finalized market policies for the ACA's second open enrollment period, while continuing the tradition of leaving a few important issues to-be-determined. Read more »

A new voice for insurance industry trade group


A media specialist who shares roots with Affordable Care Act foes is taking the communications helm of AHIP, tasked with defending an industry in transition and often under scrutiny for narrow networks and premium affordability. Read more »

New model for market-based Medicaid emerges


As an alternative to traditional eligibility expansion, one Republican hopes to bring consumer-directed insurance to Medicaid while also bridging a gap in the lower end of the group insurance market. Read more »

Some payers, providers sculpting their own ACO models


Although accountable care organizations are still in their nascent stages, a few large provider groups and payers may be ahead of the curve on operations and performance. Read more »

Big insurers try to sway national transparency with new venture


Next year, when Americans go looking for the best surgeon or cheapest MRI, many will have free access to a new comparison service started by three insurance giants. Read more »

Young enrollees may pose more risks than thought


Several million young people purchasing subsidized exchange plans was greated as a positive development for all involved. But being young does not mean being free from chronic or acute illness, as early data on one insurer's new enrollees shows. Read more »

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 »

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