Medicaid and CHIP

April 14, 2014 | Anthony Brino

As payers on behalf of states and the federal government, Medicaid managed care organizations have the potential to drive reforms, and if they don't, they could be on the chopping block.

April 4, 2014 | Anthony Brino

Michigan, the federal government and some of the country's largest insurers are getting ready to test key ideas about how to improve healthcare for some of the most vulnerable Americans.

March 20, 2014 | Anthony Brino

The largest national dual eligible demonstration project is taking a belated start in California, amid concerns from patient advocates. The concern surrounding the project indicates that new managed care plans have a long way to go, both in fixing problems in the system and getting buy-in from beneficiaries.

March 18, 2014 | Joe Burns

As Oregon transforms how it delivers care to 780,000 Medicaid patients, it hopes to generate better outcomes at lower costs. The problem is these goals conflict with hospital's traditional reliance on revenue from ER visits and inpatient stays.

March 17, 2014 | Anthony Brino

The Medicaid and CHIP Payment and Access Commission is out with its biannual report, proposing a number of changes to eligibility, premiums and disclosure policies, including some intertwining with exchange health plans.

March 13, 2014 | Anthony Brino

With researchers expecting a lot of fluctuating eligibility between Medicaid and exchange subsidies among lower-income consumers, states and insurers will have to devise new ways to solve the problem of continuity of care disruptions.

March 12, 2014 | Anthony Brino

Federal healthcare auditors think Medicaid managed care organizations aren't doing enough to combat fraud and that states might have to step in with policy changes.

March 11, 2014 | Anthony Brino

WellPoint's Amerigroup is the first Medicaid plan in the nation to use a health record chip that enthusiasts are calling a "breakthrough health IT solution."

March 10, 2014 | Anthony Brino

After a one year delay, the federal government is giving states a framework to create insurance programs for low-income residents earning above the Medicaid eligibility threshold, potentially encouraging more experimentation with public payer policies.

March 10, 2014 | Mary Mosquera

While many states have been challenged to expand their insured populations in ways encouraged by the Affordable Care Act, Ohio and Kentucky have leveraged their distinctive political and business climates to find early success.

March 4, 2014 | Anthony Brino

Colorado is moving ahead with an experiment for Medicare-Medicaid eligible beneficiaries, or "dual-eligibles," using a payment system many others are trying to abandon. But the state's approach incorporates a variation on the concept of the accountable care organization that's showing promise elsewhere.

March 3, 2014 | Anthony Brino

The number of people determined eligible for Medicaid since the launch of new insurance marketplaces is approaching 10 million, a potential boon to managed care plans and safety providers even in states that are not expanding the program.

November 20, 2013 | White Papers
Whether they realize it or not, most healthcare payers are losing millions of dollars each year across activities such as COB, subrogation, eligibility, MSP validation, and more. Fortunately, a new generation of "intelligent" cost containment solutions helps cut the losses and achieve significantly improved recoveries, cost avoidance, and increased revenue - all of which support health reform priorities such as medical loss ratio and waste and abuse efforts. This white paper details real-world examples of "intelligent" cost containment success, best practices for improvement, and more.

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.

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.

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