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State Exchanges View All →

New Obamacare Study Considers What Happens When Generous Government Subsidies End

6 days ago

A large subsidy program that has helped insurers offering Affordable Care Act (ACA) compliant coverage in the individual market expires this year.

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What would happen to the ACA’s marketplaces if UnitedHealth bailed?

2 weeks ago

UnitedHealth Group has already ditched its Affordable Care Act health plans in three states, but a new analysis shows that even if the health insurance conglomerate exited all of its markets, the negative impact to competition and premium prices would be limited to confined areas.

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Insurers May Leave Obamacare Markets, But Don’t Expect A Mass Exodus

2 weeks ago

UnitedHealth Group UNH -0.51% is slowly beginning to shed light on how many markets it will leave where it sells subsidized private coverage on public exchanges under the Affordable Care Act.

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The Effect of the ACA’s Cost-Sharing Reductions on Out-of-Pocket Costs

1 month ago

The Affordable Care Act’s (ACA) cost-sharing reductions vary by plan making the out-of-pocket (OOP) costs for the qualifying patients very different, found a new study.

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How Will the Affordable Care Act’s Cost-Sharing Reductions Affect Consumers’ Out-of-Pocket Costs in 2016?

1 month ago

The effect of the ACA’s cost-sharing reductions on consumers’ OOP costs varies widely depending on plan choice.

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Looking for Affordable Care Act activity for a particular state? Select here to find out what's going on:

Medicaid View All →

85% medical-loss ratio in final managed Medicaid rule

6 days ago

CMS also punted to the states to determine network adequacy.

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The ACA and Medicaid Risk Corridors

2 weeks ago

The poor results from the Exchanges by United Healthcare stands in stark contrast to the company’s overall profitability-indicating healthy profits from their other books of business, especially Medicaid.

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Rewarding value over volume — not so easy for safety-net hospitals

4 weeks ago

Safety-net hospitals are uniquely vulnerable under programs that reward and penalize healthcare providers on quality performance. Is there any way to shield their already thin margins from increasing financial pressures?

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The Role of State Medicaid Programs in Improving the Value of the Healthcare System

1 month ago

Across the country, states, insurers, providers and consumers are driving value into the health care system by transforming the way care is paid for, with the goal of improving the quality and cost of the nation’s health care system. Our survey of state Medicaid programs (n=34), a sample of Medicaid managed care organizations (MCOs) (n=5), […]

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P4P Program in Medicaid ACO Does Not Live Up to Expectations

2 months ago

The sports adage “that’s why we play the game” (often paired with the “on any given Sunday” adage) can perhaps be tweaked for academia. How about: “That’s why we do the studies.”

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Emerging Healthcare Models View All →

Anthem hatches another hospital joint venture, this time in Wisconsin

2 weeks ago

Roughly 18 months after Anthem rocked the healthcare business community with a new provider-insurance alliance in California, the health insurer has formulated another similar project. Anthem and Aurora Health Care will co-own a new health insurance company.

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41% of Providers, Payers Adopt Value-Based Care Reimbursement

2 weeks ago

Along with value-based care reimbursement, involving other healthcare settings in patient engagement could be beneficial for reducing costs.

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CMS unveils new risk-based primary care model: 13 things to know

3 weeks ago

CMS announced a new primary care initiative Monday designed to improve primary care by helping practices transition to value-based care models.

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Aetna Selects New Century Health to Launch a National Program in Cancer Care Quality Management

3 weeks ago

Aetna announced that it has selected New Century Health (NCH), a leader in specialty care management, as a preferred national solution partner for oncology.

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Humana Launches Value-Based Orthopedic Specialty Care Model in Ohio

2 months ago

Humana is partnering with five leading orthopedic specialty groups in Ohio to launch a value-based bundled payment care model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures.

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Insurers View All →

Centene profiting from ACA plans, Medicaid expansion

5 days ago

UnitedHealth Group may be abandoning most of the Affordable Care Act’s insurance exchanges due to steep losses. But Centene Corp. is doing just fine in the marketplaces.

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UnitedHealth Quits More Obamacare Markets, Exiting Kentucky

6 days ago

UnitedHealth Group Inc. will pull out of Kentucky’s individual marketplace for Obamacare plans, bringing to 26 the number of states the health insurer is quitting next year.

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Insurers air risk-adjustment concerns in meeting with feds

3 weeks ago

CMS open to tweaking program, but skeptical of some stakeholder proposals.

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What Risk Adjustment Does — The Perspective Of A Health Insurance Actuary Who Relies On It

1 month ago

For decades before the Affordable Care Act (ACA), American health insurers were very good at avoiding enrolling people who were likely to be high-cost in the individual (or “non-group”) health insurance market. That all changed on January 1, 2014 with the ACA.  Despite the “guaranteed-issue” requirement, we can’t assume insurers truly offer coverage to everyone […]

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