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State Exchanges View All →

Narrow Physician Networks Prevalent in Exchange Plans

1 week 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

2 weeks 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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HHS Grants Three States Conditional Approval To Create Exchanges

3 weeks ago

HHS has granted conditional approval for state-run exchanges in Arkansas, Delaware and Pennsylvania, ahead of an expected Supreme Court decision on the legality of subsidies for U.S. residents purchasing health plans through the federal exchange.

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HHS approved three new State Exchanges ahead of King decision

3 weeks ago

The Obama administration has given the go-ahead to Arkansas, Delaware and Pennsylvania to switch from federally facilitated health insurance marketplaces to state-based ones.

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Obamacare Insurers Seek 10% Rate Increases or More on Many Plans

1 month ago

U.S. health insurers are submitting their 2016 rate requests for Affordable Care Act policies, with some asking for big increases as they adjust to customers who’ve recently gained coverage through the marketplaces.

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Medicaid View All →

CMS considering ACO-style care model for dual eligibles

2 weeks 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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Massive CMS rule seeks to align Medicaid managed care with Medicare Advantage and marketplace plans

1 month ago

Yesterday, the US Centers for Medicare & Medicaid Services (CMS) published its long anticipated proposed rule on Medicaid managed care.  The ambitious proposal represents the first update to managed care regulations since 2002.

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Medicaid MCO rule under fire for introducing medical loss ratio

1 month ago

The Centers for Medicare & Medicaid Services (CMS) released its proposed rule to update Medicaid managed care organization (MCO) regulations yesterday, and the rule is already under fire for proposing a medical loss ratio (MLR) of 85 percent for managed care plans.

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Medicaid Health Plans Face Quality And Performance Ratings

1 month ago

Just as millions of Americans enroll in the expanded Medicaid health insurance program under the Affordable Care Act, the Obama administration is rolling out new rules that will measure quality and performance of private plans that provide such benefits.

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Sixteen states are now preserving Medicaid Pay Bump

2 months ago

Sixteen states and Washington, DC, are using their own money to keep Medicaid rates for primary care physicians at or near Medicare levels in 2015, but whether the raise has improved access to care is debatable, according to a new study.

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Emerging Healthcare Models View All →

Payment Reform: Will Gain Follow Pain?

1 week ago

A special session held during the annual meeting of the American Society of Clinical Oncology (ASCO), titled “Payment Reform in Oncology: The Way Forward,”[1] explored both the progress made and the barriers that stand in the way of payment reform.

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How bundled payments can standardize care quality

2 weeks ago

Value-based care will reduce variation in quality.

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CVS Health, Four Leading Health Care Organizations Enter New Clinical Affiliations

2 weeks ago

CVS Health announced that it has entered into new clinical affiliations with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group, PC in New York.

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High Deductibles, Narrow Networks will help hold down Medical Cost trend in 2016

3 weeks ago

Although the introduction of new specialty drugs and increased investments into personal health data security, moderating forces will keep healthcare spending growth in check in 2016, according to a report from PwC’s Health Research Institute.

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The Payment Reform Landscape: Public-Private Alignment Is Critical

3 weeks ago

In the past few years, a growing number of state health agencies have formed partnerships with large, private employers and/or commercial health plans to realign efforts and resources and change how we pay for health care.

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Insurers View All →

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

2 days 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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$6.8 billion acquisition puts Centene in the Medicare business

2 days ago

The decision to acquire Health Net was obvious, according to Centene’s chairman, president and CEO, Michael Neidorff, who referred to the pending multibillion-dollar cash and stock deal Thursday as “the perfect marriage” for Centene.

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Premium charges vary by insurer type, market size and competition

3 days ago

RWJF report explores which companies can charge high rates, which keep prices competitive.

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Aetna To Buy Insurance Rival Humana For $37 Billion

3 days ago

Health insurer Aetna on Friday said it would buy smaller rival Humana for about $37 billion in cash and stock, in the largest ever deal in the insurance industry.

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How health plans with high deductibles became the new normal

1 week ago

More than a quarter of employers provide high deductible plans for their employees, and, last year, they made up 85 percent of all plans sold on the Affordable Care Act’s health insurance exchanges.

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