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Pressure mounts to overhaul military health plans


The U.S. Department of Defense can look like a benefits company "that occasionally kills a terrorist." The agency has to overhaul its healthcare contracting, especially TRICARE, according to advocates. Read more »

UHG upgrades mobile app, looks to food rewards


The nation's largest insurer is making leaps in the journey of consumer-driven healthcare, improving its digital offerings and investing in new member incentives. Read more »

Figuring out if a doctor is in network harder than it should be


"Is this doctor in my insurance network?" is part of the litany of questions asked when considering whether to see a particular doctor. Unfortunately, the answer may not be a simple yes or no. Read more »

Will transparency make certificate of need moot?


After decades of research showing at best mixed benefits, certificate of need programs are starting to look antiquated and deleterious in the age of consumer-driven healthcare. Read more »

With or without co-ops, insurance to follow consumers


Whether or not more co-ops falter, many insurers could learn from some of their goals and experiments, including in primary care. Read more »

Love for health reform and its discontents


After a weekend of Merlot, brie, oysters and chocolate (and maybe more snow), a sampling of the most prolific prose from an annual healthcare tradition: health policy valentines.

CMS calls on insurers to improve cancer care with Medicare


Medicare is looking for commercial insurance partners to join a multi-payer, physician-led effort aimed at "transforming" oncology and helping financing become more sustainable. Read more »

Fertile individual market lets brokers avoid extinction


The predicted demise of health insurance brokers may have been premature. Industry veterans and entrepreneurs are carving out niches and expanding their roles in the new market. Read more »

HIX auto-enrollment turbulence on the way


Changes in open enrollments to come and evolving state and federal policies promise new uncertainties for insurers trying to soundly price their plans and retain membership. Read more »

Anthem hack spurs momentum for data protection regulation


In the wake of Anthem's massive data breach, a storm of class action lawsuits are raising concerns about information protection, liability and regulation. Read more »

Rite Aid jumps into PBM game


The country's fourth largest drugstore chain is making a $2 billion bet on the business of pharmaceutical benefits management, amid rising drug prices and demand for retail consumer healthcare. Read more »

VC-backed startup insurer sets sights on expansion


One of the most ambitious startup insurers, a self-described "better kind of insurance company," may soon start selling in some of the nation's largest markets, including the world's technology capital. Read more »

Uncertain prognosis for co-ops


How many more ACA cooperative insurers will go out of business? At least some are going to be hard pressed. Read more »

HIX data integrity still lacking


As the ACA's second open enrollment period closes, many health plans are likely to find themselves in the midst of a lot of data analysis and submission work, to ensure a good consumer experience and fair deals from the 3Rs. Read more »

Texas Blues, independent docs saddle up for accountable care


The southwest's largest Blue Cross insurer is hoping to find value by working with independent physicians and the state medical association, as powerful health systems loom in the field of ACOs. Read more »

Mixed results in PCMH bet


Medical homes are a simple, compelling idea: Give primary-care doctors resources to reduce preventable medical crises, to reduce hospital visits, improve lives and save money. But it's not so easy in practice. Read more »

Highmark girds for member retention in bout with UPMC


Despite some membership losses, the country's fourth largest Blue Cross insurer is boasting fairly strong customer retention as a sign of viability for its integrated network strategy. Read more »

Independence primary care venture gains momentum


An ambitious primary care company co-owned by Philadelphia's dominant insurer is growing, recruiting new provider partners and getting scale for more patients. Read more »

Hacking the Blues: Huge health breach hits Anthem


The nation's largest Blue Cross Blue Shield insurer has to find its way out of what may be the largest healthcare data breach ever, casting a dark cloud on the outlook for a prosperous, transformative year. Read more »

Employers brace for looming Caddy tax


Government budget forecasters are predicting some potentially disruptive consequences from the Affordable Care Act's pending Cadillac Tax. Read more »

For drug cost crisis, Obama wants to let the government negotiate


With the surging costs of specialty drugs, what was once unthinkable in American healthcare is starting to look like a viable idea that the President is pushing. Read more »

New CEO at Kansas City Blues


A regional Blue Cross insurer in the southern Midwest is turning to a long-time marketing executive to guide it into the next generation of health insurance. Read more »

Garden State Blues bank on PCMH


New Jersey's largest insurer is expanding its medical home program in an effort to boost primary care access and member satisfaction, as new competitive threats loom from non-traditional insurers. Read more »

Aetna sees bright future despite uncertainty


Aetna is positioning itself to ride out the early storms of health reform and end up plying the new waters sustainably. Read more »

Highmark concedes in maternity access fracas


Pennsylvania's largest insurer has agreed to a broader interpretation of continuity of care provisions in a long-term accord with its main rival, while also touting what it sees as positive membership choice trends. Read more »

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