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State Exchanges View All →

High costs plague some state-run health insurance markets

2 days ago

State-run health insurance markets that offer coverage under President Barack Obama’s health law are struggling with high costs and disappointing enrollment.

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Small business insurance exchanges are off to a rocky start

3 weeks ago

Millions of Americans have health insurance because of the Affordable Care Act, but there’s one area where enrollment has significantly dragged. Few small businesses are getting coverage through the law’s online insurance exchange.

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Rx Drug Spending Down Among New Exchange Enrollees

3 weeks ago

New enrollees in the Affordable Care Act’s exchanges in 2015 spent less on prescription drugs and tended to be younger than new enrollees last year, according to a report from pharmacy benefits manager Express Scripts.

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Narrow Physician Networks Prevalent in Exchange Plans

1 month ago

More than four in 10 silver health plans on the state and federal health insurance exchanges have narrow physician networks, defined as 25% or less of the physicians in the area, according to a newly released report from the Leonard David Institute of Health Economics at the University of Pennsylvania.

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States Take Few Steps to Fill Gap if Supreme Court Blocks Health Subsidies

1 month ago

As the Supreme Court prepares to rule on whether to block health insurance subsidies in 34 states that use the federal insurance exchange, Pennsylvania and Delaware are the best prepared.

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Medicaid View All →

Hospitals pay big price for lack of Medicaid expansion

6 days ago

But providers in expansion states reaping benefits.

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Medicaid Enrollment surges, stirs worry about State Budgets

1 week ago

More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years.

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Medicaid expansion roundup: Waiver programs gain steam in GOP states

2 weeks ago

 In the wake of the King v. Burwell ruling to uphold federal health insurance subsidies, advocates continue to push for Medicaid expansion in some of the most unlikely of states.

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Maryland Medicaid To Launch ACO-Like Model For Dual Eligibles

3 weeks ago

The Maryland Department of Health and Mental Hygiene (DHMH) is planning to launch a pilot Accountable Care Organization-like model (ACO) for individuals dually-enrolled in Medicaid and Medicare who live in Baltimore City. 

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CMS considering ACO-style care model for dual eligibles

1 month ago

A Centers for Medicare & Medicaid Services executive says the agency is considering developing an accountable care organization-type model for beneficiaries who qualify for both Medicare and Medicaid.

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Emerging Healthcare Models View All →

North Carolina health systems consider starting insurance plans

1 week ago

One large health system in North Carolina is ready to launch a Medicare Advantage plan, and two others are mulling the pros and cons of becoming a payer.

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ACOs Increasingly Assuming Population Health Management Duties

2 weeks ago

Accountable care organizations (ACOs) have exploded in popularity over the past three or four years as value-based reimbursement takes hold in the healthcare industry, and their work has rapidly built momentum towards bringing population health management to hundreds of communities. 

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Bundled payments a better model than accountable care organizations

3 weeks ago

Mixed results among CMS programs causes faith to sink in ACOs.

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Cigna and Providence-Swedish Health Alliance ACO Partner to Improve Quality and Lower Medical Costs

3 weeks ago

Cigna and Providence-Swedish Health Alliance ACO in Western Washington have launched a collaborative care initiative that aims to improve patient access to health care, enhance care coordination, and achieve the goal of improved health, affordability and patient experience.

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Value-Based Care Profile: Iora Primary Care Grows Quickly on Pure Value-Based Payment

3 weeks ago

Iora Primary Care doesn’t believe in fee-for-service payment and the primary care company, founded as value-based payment was gathering steam, is now growing rapidly, is expanding to other insurers after inking a deal with Humana last year.

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Insurers View All →

Anthem Agrees to Buy Cigna for $48.4 Billion

5 days ago

Deal, which needs regulatory approval, would help reshape health insurance industry.

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Are private exchanges the next big thing in health plans?

6 days ago

Experts say demand will increase due to increasing health plan costs and ‘Cadillac’ tax.

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Aetna, Humana deal puts focus on reimbursement models

3 weeks ago

With Aetna’s market share set to balloon next year after its takeover of Humana wraps up, the insurer is trying to assuage health systems that might fear greater reimbursement pressure.

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Health Insurance Companies Seek Big Rate Increases for 2016

3 weeks ago

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.

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Aetna’s $37B Humana Deal Expands Role In Medicare’s Value-Based Care Push

4 weeks ago

The complementary combination brings together Humana’s growing Medicare Advantage business with Aetna’s diversified portfolio and commercial capabilities to create a company serving the most seniors in the Medicare Advantage program.

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