Policy and Legislation

November 10, 2014 | Anthony Brino

What was once thought to be a Hail Mary attempt by Affordable Care Act opponents is now starting to look like a clear pass with a chance of being caught.

November 5, 2014 | Anthony Brino

Health insurers in the nation's largest market are breathing a collective sigh of relief after escaping a new rate review system, but they may have to fight the battle again.

November 5, 2014 | Anthony Brino

How will a long-time insurance manager fix the crisis in a state with some of the most expensive and advanced healthcare on the planet?

November 3, 2014 | Anthony Brino

Already big and still growing, the U.S. healthcare system in 2015 will be scrutinized inside and out for signs of financial problems, the federal government's health investigator promises.

October 30, 2014 | Anthony Brino

Many health insurers have spent close to a century operating under fee-for-service and are now changing course. Some new payers founded post-health reform, however, are trying to hit the value-based ground running.

October 17, 2014 | Jay Hancock

Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don't include hospital benefits. Now the administration is concerned too.

August 22, 2014 | Michelle Andrews

How much leeway do employers and insurers have in deciding whether they'll cover contraceptives without charge and in determining which methods make the cut? Not much, as it turns out, but that hasn't stopped some from trying.

August 7, 2014 | Anthony Brino

Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come.

July 28, 2014 | Anthony Brino

Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans.

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 24, 2014 | Anthony Brino

Americans across the country may be pleasantly surprised to get a small check from their health plans this summer, but insurers may need to plan better if they want avoid an administrative hassle.

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.

June 2, 2014 | White Papers
Health plans must not only address today’s security threats, but plan for unexpected emerging risks of the new healthcare marketplace.

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 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.

August 27, 2013 | White Papers
In the coming months, payers will assume risk as a predicted seven million previously uninsured Americans enter the healthcare system. Terri Bellmore offers commentary on the important and timely topic Risk Adjustment and Revenue Management in the Health Insurance Marketplace.

December 12, 2011 | White Papers
Curtailing the massive drain caused by waste, abuse and fraud in healthcare has never been more important. New payment models are on the horizon, including bundled payments, and greater emphasis is being placed on payment for outcomes. Given the magnitude and visibility of the problem, insurers need to avail themselves of advanced and effective means to reduce wasteful, abusive and fraudulent medical spending in the most efficient way possible. This demands a more holistic approach across the payment continuum, using technologies that not only address issues from multiple angles but also facilitate cross-organization partnership. Read more now.

June 22, 2012 |

By David Williams

There's a good debate still to be held in this country on health reform, but only if the Republicans step up to the plate with serious ideas. I'm not that optimistic, but am not giving up hope yet. In Massachusetts the Senate race between Scott Brown and Elizabeth Warren still has the potential for serious engagement, but so far it looks like most of the campaign is about non-substantive issues.

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