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Are insurance markets too concentrated?


The competitiveness of America's state and regional health insurance markets is once again under question as patients and providers demand greater value propositions from payers. Read more »

At-home diagnostic tool may improve colon screening


A new molecular diagnostic approved by Medicare and Medicaid is among the first non-invasive alternatives to colonoscopies, a potential boon for patients and payers but also a new piece of the personalization puzzle to manage. Read more »

Seniors to see new cost-sharing, benefit options


Cost-sharing in traditional Medicare is on the rise, and benefit designs in Medicare drug plans are changing. Read more »

Complications, costs to consider in robotic surgery reimbursement


As more providers adpot robotic surgery technology, more information on comparative effectiveness is raising questions about costs and benefits. Read more »

State Medicaid units divided on approach to Sovaldi


The new hepatitis C treatment Sovaldi has driven debate over drug costs for close to a year, but it’s also been a case study in access and coverage in public payer programs. Read more »

Hospitals try to absorb shortfalls


In one large state, it is up to individual hospitals and health systems to find creative ways to bend the cost curve and best meet local needs. Read more »

Tiered network rankles Highmark, UPMC accord


In a new market for western Pennsylvania healthcare lives, Highmark and UPMC are finding old disputes lurking, adding to consumer confusion amid a new product launch and open enrollment. Read more »

CMS clarifies ACA Medicaid tax


Insurers with Medicaid managed care plans can breathe one big sigh of relief, but there are still other things with the insurance fee in Medicaid to worry about. Read more »

Big Pharma's long road to mobility


The industry that prides itself on being at the cutting edge of biomedical research is at the back end when it comes to adopting mobile technology for healthcare professionals and patients. Read more »

Rule changes will shake up plans serving those with disabilities


Insurers that manage long-term care and supports for individuals with disabilities in their home or community will have to assure that beneficiaries can interact with their community and make more of their own life choices. Read more »

Pay-for-performance: Patient-centered care or just bureaucracy?


After years of research, design, pilot programs and technology investment, the movement for quality improvement and pay-for-performance is facing skepticism from outside and within. Read more »

What payers need to know about the new HP


Hewlett-Packard revealed on Monday that it intends to break itself into two distinct entities and, in so doing, shared a little about how it will all work. Read more »

How big is too big for hospital consolidation?


In Massachusetts, the expansion of the state's largest health system is offering a fractious case study of clinical integration and payment reform. Read more »

Walmart targets complexity with broker venture


A few months after opening its own primary care clinics, Walmart is expanding its insurance sales program, in what could be another step toward underwriting. Read more »

Medicaid providers seek right to sue for payment increases


In the many quests for sound Medicaid reimbursement, healthcare provider advocates may soon have another tool to compel state governments. Read more »

End to Medicaid primary care bump raises sustainability questions


Health plans, providers and legislators need to increase the number of primary care practitioners participating in Medicaid as the wait for many to access care is inadequate and getting worse as enrollment mushrooms. Read more »

Preventing HIX drug benefits horror stories


Drug benefits stand as some of the most consequential consumer confusions that can arise in public exchanges, increasing the onus on insurers to improve the design and explanation of formularies. Read more »

Walgreens raises wellness ante


CVS recently made the bold move of quitting tobacco as part of its retail health ambitions. Now, a chief rival is upping the bet, trying to target consumer incentives and enter a wellness market in flux. Read more »

Mount Sinai bets on Medicare Advantage


Another health system is taking a step into insurance with Medicare Advantage, banking on seniors wanting access to a prestigious brand. Read more »

Insurers try out mobile wellness with Apple platform


More and more insurers are getting on to the smartphone and mobile health wave, trying to both attract tech-savvy members and try out new wellness ideas. Read more »

The risk corridor funding paradox


Here's a tangled web: It appears that some of the federal government's profit-loss payments to insurers are at once obligated and prohibited. Read more »

United snags practice management developer


United Healthcare's shopping spree continues, as it acquires a Texas company with practice management, revenue cycle, physician referral management and other ambulatory-focused technology. Read more »

Payers need personalization, new tech to stay relevant


The traditional health insurance business model is on the verge of a cataclysmic shift toward individual consumers. While that will require moving away from the old IT running within many payers, it also makes now a great time for reinvention, venture capitalists argue, if not the only opportunity. Read more »

A patch for the painkiller cost crisis: dependence treatment


Health insurer spending on treatment for painkiller dependence is on the rise, and proving to be one of several tools needed to curb the epidemic of opioid addiction. Read more »

Can payment reform evolve while shared-risk lags?


Health insurers are betting on value-based payments, broadly defined, but providers still seem skittish. Read more »

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