Health Insurance Exchange

August 1, 2014 | Anthony Brino

Premiums for exchange plans in California are looking pretty affordable. Is this because insurers are fearful of a rate review process that might be approved by voters in the fall, or a large, diverse market spreading out risk?

July 30, 2014 | Anthony Brino

A new portrait of the uninsured and newly-insured is emerging, with a confluence of factors shaping who is and isn't enrolling in Medicaid or private plans.

July 29, 2014 | Anthony Brino

Among the many challenges in year two of federal exchanges, the process of auto re-enrollment is bringing the potential of convenience and disruption, for both consumers and insurers.

July 28, 2014 | Anthony Brino

Insurers trying to ride the wave of private exchanges need to be careful not to get swept up or knocked overboard amid varying business models and high customer expectations.

July 25, 2014 | Anthony Brino

While some state exchange executives exited their exchanges amid foundering technology and low public esteem, the director of one successful state HIX has landed in the growing private exchange unit of a large national insurer.

July 25, 2014 | Anthony Brino

Ahead of the next open enrollment period, federal regulators are trying to clarify rules for member non-payment and grace periods, but insurers and providers may still have lingering concerns about getting paid.

July 22, 2014 | Michelle Andrews, Kaiser Health News

If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts.

July 22, 2014 | Anthony Brino

In the latest battle of the health reform wars, four words could bring down the Affordable Care Act's main insurance expansion policy, depending on which court interpretations gain traction.

July 17, 2014 | Anthony

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.

July 16, 2014 | Anthony Brino

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.

July 15, 2014 | Anthony Brino

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.

July 15, 2014 | Anthony Brino

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.

May 19, 2014 | White Papers
If your organization enters or changes data manually, or is using a series of macros cobbled together to automate enrollment, claims reprocessing, or panel updates, you’re probably losing time, money, and risking data quality. This study explores the causes, prevalence, and repercussions of these traditional data practices for payers, then shares innovative ways to conquer inefficiency with automation technology.

March 11, 2014 | White Papers
For health insurers, data integrity and visibility are key to successful integration with the Federal Marketplace. However, complex processes and trivial errors can lead to data gaps that impact revenue, profitability and member satisfaction. Adopting a standarized approach to data integrity early in the process is critical to succesfully adapting to the technologies and processes of the Affordable Care Act.

October 30, 2013 | White Papers
This visual industry primer answers key questions about health insurance exchanges and includes data points from leading consulting firms. Read this piece to get grounded on the new world of health insurance marketplaces, and gets answers to some basic industry questions including: 1) How will people buy health insurance in the post-reform landscape? 2) What’s the difference between defined contribution and defined benefit? 3)How do public and private exchanges differ? 4) How does a single-insurer private exchange work?

October 30, 2013 | White Papers
This summer with the October 1 launch of public health exchanges looming, Array Health surveyed health insurance executives to get their perspective on the changing marketplace. Read this report to discover their opinions on key questions surrounding exchanges including: 1) What percentage of insurers will participate in both private and public exchanges? 2) How aware are employers of the defined contribution funding model? 3) How many “young invincibles” will comply with the ACA individual coverage mandate?

October 17, 2013 | White Papers
For a company that provides medical, dental, and vision coverage to more than 25 million people nationwide and processes over 50 million claims every year ensuring call resolution is key to organizational performance. Thanks to healthcare reform and an anticipated increase in calls from both members and providers, this organization needed to streamline the cost of new customer service representatives. See how training helped streamline the onboarding process by 30% and save over $500,000 annually.

October 9, 2013 | On Demand Webinars
The healthcare sector is going through massive transformation. Payers have to invest in readiness around data delivery to federal and state or multiple health insurance exchanges before Jan 1, 2014 deadline. While the ICD-10 adoption deadline has been pushed back due to industry pressures on regulator - it is still a huge undertaking for any healthcare entity that touches diagnostic or procedural codes. These are just some of the projects that are converging on healthcare IT teams this year. For healthcare CIOs and IT teams and especially application development teams this project overload translates into a cascading capital and operational cost burden. Learn how Presbyterian reduced storage, operational costs and realized significant productivity benefits around critical business processes.

October 9, 2013 | White Papers
Healthcare reform is transforming the US medical insurance sector - creating a dynamic and competitive new market with compelling opportunities for growth. But do you have the necessary responsiveness to capitalize on these opportunities? Here are the five compelling ways technology investment delivers agility you need - and how.

July 1, 2013 | White Papers
The launch of new Health Insurance Marketplaces in all 50 states on October 1 accelerates an ongoing transition from the employer-driven payer model of U.S. healthcare toward a new era of consumerism. Health plans will be required to treat customers as individuals and use multiple channels to take their products to market. This paper will explore how Dell’s proven expertise in building and managing Health Insurances Exchanges can help you succeed in this new world.

April 4, 2013 | White Papers
Accountable care offers the nation’s ailing health care system new hope — but it isn’t a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer™ Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.

June 20, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 20, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.

January 9, 2012 | White Papers
As healthcare payers prepare for an undefined future, they can benefit by looking at their technology infrastructure and IT systems, and examining how well these systems can support change. Healthcare payers can leverage technology to provide the flexibility and agility they need to manage change, without even knowing what that change will be. In particular, a modern, rules-based billing system can help payers be ready to support new market segments, products, services and regulations as reform continues to evolve. Learn more about how to manage the uncertainty around reform, and how billing can help.


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