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Direct care company wants to grab self-funded group biz

A direct primary care company is targeting employers with a new self-funding model that could spell disruption for the third-party administrator business. Read more »

Diabetes bundling shows prevention promise

The diabetes and obesity epidemics mean more Americans may suffer from heart disease before they turn 65, challenging payers to craft better intervention models that help prevent serious cardiovascular events and increased spending on acute care. Read more »

Errors and harm wreaking havoc

It's a chilling reality often overlooked in annual mortality statistics: Preventable medical errors persist as the number three killer in the U.S. and the source of great waste. Read more »

Another insurer exits Medicaid managed care

After taking losses of $40 million over three years, BlueCross BlueShield of Western New York is withdrawing from the Empire State's Medicaid managed care program in six of its eight counties of operations. Read more »

Insurance professionals need to use CDHPs

More and more, health insurance professionals who design consumer-driven and high deductible plans are using them personally, a trend that bodes well for their improvement. Read more »

UnitedHealth plots exchange market surge

Premiums for exchange plans in many states are set to increase anywhere from slightly to significantly, but there's new competitive pressure coming as the nation's largest insurer starts flooding markets. Read more »

Struggling Blue finds a new chief

After one of its worst years ever, one Blue Cross company is banking on an insider and native son to lead a comeback. Read more »

Pennsylvania insurer's ACO marks hospital gains

In a region dominated by one insurer and teeming with health systems, accountable care models are gaining provider acceptance but still accumulating evidence. Read more »

Provider giant primes for health plan expansion

After quietly building a small insurance unit, one of the nation's largest health systems is launching a new health plan brand that could pose more competition for established insurers. Read more »

Insurance services firm acquires HealthPocket

The healthcare tech boom continues, as one of the most-heralded consumer insurance comparison startups was acquired by an insurance services firm hungry for growth. Read more »

PBMs threaten sustainability of Medicare, Part D plans

Evidence from recent federal enforcement actions suggest pharmacy benefit managers are exposing public-payer managed care plans to problems that could send shivers up executive's spines. Read more »

Without Medicaid, hospitals may pay patient premiums

Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option. Read more »

Employers, workers migrating to HSAs

Group plans are increasingly expanding their consumer-directed health plans with health savings accounts, after toying with lower deductibles and reimbursement account wrapping. Read more »

State plan association names new executives

One of the nation's largest health insurance advocacy groups is welcoming in a new chief executive, amid a tumultuous regulatory environment. Read more »

States have options to fill Medicaid reform gaps

Amid record enrollment in Medicaid and state concerns about the program's budgetary sustainability, the federal government is offering new financial support and policy options. Read more »

Regulatory power becomes center of insurance debate

In California, insurers and regulators are fighting for control of the post-reform insurance market. Read more »

As a rule, MCR regulations not negative for insurers

With federal rules governing health plan spending looking like they're here to stay, insurers are making inroads on compliance, although they will hope for possible tweaks in the future. Read more »

Pockets of group membership migrate to public exchanges

As Affordable Care Act exchanges bring health plans to previously uninsured Americans, there are also market segment transitions that could prove favorable for risk pools. Read more »

Blues continue march away from fee-for-service

Trying to help transition the American healthcare system beyond fee-for-service, Blue Cross and Blue Shield companies are starting to reach new reimbursement milestones. Read more »

UnitedHealthcare oncology incentive program generates savings

UnitedHealthcare's bid to change financial incentives for oncologists has led to some promising, though somewhat mixed results. Read more »

Cigna finds gains in physician collaboration

Joining its peers in touting accountable care, Cigna has met a fairly ambitious goal set two years ago, but more time is needed to test the strategy's sustainability. Read more »

Provider-owned plan tries for lean data methods

One regional insurer is using a new approach in provider network management, as it aims to tackle a laborious administrative process. Read more »

HIX network, PPO confusion sparks class action suit

One of the country's largest health insurers is being accused of having misleading information on doctor and hospital network participation for EPO and PPO plans sold in the state exchange. Read more »

Aetna sees promise in new heart disease diagnostic

With spending on diagnostics alone for cardiovascular disease likely to be a major challenge for insurers amid the baby boom wave, Aetna is turning to an emerging option as part of a strategy to avoid invasive tests and treatments. Read more »

Highmark health system inks affiliation deal to up oncology care

The insurer-owned Allegheny Health Network is partnering with a national cancer center to offer new therapies and trials in western Pennsylvania, a sign of heightening regional competition and the emergence of new models for pursuing innovative treatments. Read more »


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