Policy and Legislation

April 1, 2014 | Tom Sullivan

Just like that, the massive code set conversion won't happen before Oct. 1, 2015 unless President Obama derails the legislation.

March 31, 2014 | Anthony Brino

New York is poised to solve one of the most pernicious consumer healthcare billing problems, and regulators think it could be a model. But for insurers, the new process may or may not be the ideal solution, especially when paired with new network requirements.

March 27, 2014 | Anthony Brino

The many moving parts in the government's ACA plan transition policies are creating a range of new complexities for premium pricing, member pools and the new risk-sharing programs.

March 27, 2014 | Diana Manos

Only five states states are making headway bringing more price transparency to healthcare markets, but they could be a model for others, especially those with all-payer claims databases.

March 24, 2014 | Anthony Brino

Physicians groups want to preserve a key antitrust exemption for self-referrals under Medicare that the Obama Administration hopes to end for a number of costly services.

March 20, 2014 | Anthony Brino

A central hypothesis underlying the case for health reform's insurance expansion is being challenged by new evidence, as the quest to reduce emergency visits and spending continues. The research also highlights ongoing concerns about primary care access.

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 19, 2014 | Anthony Brino

As Congress tries to reform Medicare, the program's independent advisor has its own suggestions, including a call to end to what has become a revenue buffer for many hospitals and an integral part of their physician acquisition strategies.

March 18, 2014 | Anthony Brino

Federal regulators are starting to finalize simmering ideas for public exchanges and also responding to consumer concerns, outlining a new quality rating system and proposals covering everything from narrow networks to loss ratios.

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 17, 2014 | Frank Irving

Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on.

March 17, 2014 | Anthony Brino

As Montana's Blue Cross company evolves under a new corporate parent, state regulators are penalizing it for some alleged past misdeeds uncovered by an audit.

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 | 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.

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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