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State Exchanges View All →

Insurers’ Drug Tiering Can Keep Sickest Patients Away

1 month ago

Researchers studying how insurers categorize prices of drugs say some payers are using a practice called “adverse tiering” to discourage high-cost patients from enrolling in their plans.

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Health Insurance CO-OPs Fight Insolvency

1 month ago

The U.S. Department of Health and Human Services announced in December that two struggling health insurance cooperatives were given emergency solvency loans.

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More PPACA exchange users get premium subsidies

2 months ago

The U.S. Department of Health and Human Services (HHS) says at least 4 million people are set to have private exchange plan coverage in place Jan. 1, 2015.

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Obama Administration to Investigate Insurers for Bias Against Costly Conditions

2 months ago

The Obama administration said Monday that it would investigate prescription drug coverage and other benefits offered by health insurance companies to see if they discriminated against people with AIDS, mental illness, diabetes or other costly chronic conditions.

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Obamacare Co-Ops Cut Prices, Turn Up Heat On Rival Insurers

2 months ago

Co-Ops are offering low premiums that are upsetting so-called “legacy” insurance plans like Blue Cross and Blue Shield affiliates that have traditionally dominated insurance markets.

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Medicaid View All →

More States Lean Toward Medicaid Expansion

4 weeks ago

In accepting Indiana’s Medicaid Expansion plan, the Obama administration demonstrated its determination to increase the number of expansion states, even if it means waiving traditional Medicaid rules.

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3.2 Million Newly Eligible Adults Enrolled In Medicaid In Early 2014, CMS Reports

1 month ago

The CMS is taking a deep data dive into Medicaid enrollment data to uncover just how many new adults have joined the state programs since the Affordable Care Act motivated many states to expand eligibility last year.

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Medicaid Reimbursement Increases Under ACA Boost Access

1 month ago

A temporary increase in reimbursements under the Affordable Care Act for primary care physicians who treat Medicaid beneficiaries resulted in easier access to appointments, according to a study published Wednesday in the New England Journal of Medicine.

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As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care

2 months ago

Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

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Medicaid Rolls Surge Under Affordable Care Act

2 months ago

Idaho, Georgia, and North Carolina did not opt to expand their Medicaid programs as part of the Affordable Care Act, but all have seen substantial enrollment increases in state health insurance.

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Emerging Healthcare Models View All →

Pioneering Pediatric ACO Drops Costs but Quality Gains Prove Elusive

4 days ago

Those involved with Partners for Kids effort hope to start national conversation about more thoughtful quality metrics.

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Summit Health and CarePayment Offer Hospital Patients Affordable Financing Option

5 days ago

Summit Health, a non-profit healthcare system in south central Pennsylvania, is partnering with CarePayment®, the nation’s leading patient financial engagement company, to offer an innovative patient payment program to patients of Chambersburg Hospital and Waynesboro Hospital.

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The Patient-Centered Medical Home’s Impact on Cost and Quality

3 weeks ago

This annual report highlights recently published clinical, quality, and financial outcomes of PCMH initiatives across the United States.

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Accountable Care Organizations: Like HMOs, but Different

1 month ago

In pursuit of greater efficiency in the United States health system, public programs and private insurers have begun to pay some hospitals and physicians differently. These new payment models take many forms, but they all impose greater responsibility for cost control and quality improvement on providers and bear some resemblance to failed health care financing […]

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Trinity Health to expand risk-based care with Heritage Provider Network

1 month ago

Trinity Health, an 86-hospital Catholic system based in Livonia, Mich., has signed a definitive joint venture agreement with Heritage Provider Network to advance its strategy of coordinating care for specific groups of patients.

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Insurers View All →

Implementing Health Reform: 2016 Benefit And Payment Final Rule, Insurance Provisions

4 days ago

This post will analyze the parts of the rule that deal with the insurance market reforms; the reinsurance, risk adjustment, and risk corridor programs; health insurance rate review; and the individual and SHOP exchanges.

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Administration Bars Health Plans That Won’t Cover Hospital Care

4 days ago

The Obama administration has blocked health plans without hospital benefits that many large employers argued fulfilled their obligations under the Affordable Care Act.

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Are insurers quietly dropping small businesses?

1 month ago

As insurers reap financial benefits from the Affordable Care Act, many appear to be raising rates for small employers to the point that they can no longer afford to provide benefits, former industry executive Wendell Potter wrote in a commentary for the Center for Public Integrity.

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Lavish ‘Cadillac’ Health Plans Dying Out as Obamacare Tax Looms

2 months ago

Large employers are increasingly putting an end to their most generous health-care coverage as a tax on “Cadillac” insurance plans looms closer under Obamacare.

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Obama Administration to Investigate Insurers for Bias Against Costly Conditions

2 months ago

The Obama administration said Monday that it would investigate prescription drug coverage and other benefits offered by health insurance companies to see if they discriminated against people with AIDS, mental illness, diabetes or other costly chronic conditions.

Read More →