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State Exchanges View All →

Aetna Is Latest Health Insurer to Quit Obamacare Markets

4 months ago

Insurer had already pulled out of most ACA health exchanges Move comes as Republicans in Congress work to dismantle law

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Health insurers’ proposed 2018 rate hikes are early ‘warning signs’

4 months ago

Health insurers are asking state regulators to approve giant rate increases for 2018 individual policies, in part because they don’t yet know if the Trump administration plans to help or hurt the Affordable Care Act’s health insurance exchanges.

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Aetna to Scale Back Presence in Affordable Care Act Exchanges

4 months ago

Aetna said today that will reduce its presence in the Affordable Care Act exchanges in 2018 as it expects losses in the business this year, the Wall Street Journal reports.

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Insurers: More premium hikes likely for exchange plans next year amid market uncertainty

5 months ago

With the individual markets facing heightened uncertainty, it is looking likely that health insurers will once again need to hike plan premiums.

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Insurers: More premium hikes likely for exchange plans next year amid market uncertainty

5 months ago

With the individual markets facing heightened uncertainty, it is looking likely that health insurers will once again need to hike plan premiums.

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Medicaid View All →

Medicaid Waiver Requests in Wisconsin and Maine Seek to Impose Work Requirements and Time Limits for Beneficiaries

4 months ago

Proposed changes to Medicaid programs in Wisconsin and Maine include work requirements and time limits in both states, as well as drug screenings for some beneficiaries in Wisconsin. 

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Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion

4 months ago

This Data Note discusses the current role of managed care in Medicaid and addresses differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.

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Medicaid Per Capita Caps Could Cut Funding for Dual Eligible Beneficiaries

4 months ago

New modeling from Avalere finds that proposals to limit per capita federal Medicaid funding growth based on medical inflation could lead to a $44 billion spending cut for dual eligible beneficiaries.

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Key Themes in Section 1115 Medicaid Expansion Waivers

5 months ago

Seven states currently are implementing the Affordable Care Act’s (ACA) Medicaid expansion to nearly all low income adults up to 138% of the federal poverty level (FPL, $16,643 per year for an individual in 2017) in ways that extend beyond the flexibility provided by the law through a Section 1115 demonstration waiver approved by the […]

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3 Key Questions: Section 1115 Medicaid Demonstration Waivers

6 months ago

Looking ahead, states are likely to continue to request waivers to implement provisions not allowed under current law; however, it is not yet clear what role Section 1115 waivers will play as the new administration and Congress move to repeal the ACA and debate possible broader changes to Medicaid financing.

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Emerging Healthcare Models View All →

Bundled Payments, Clinical Pathways Drive Cancer Care Savings

4 months ago

Oncology value-based reimbursement models used bundled payments and clinical pathways to reduce cancer care costs, but researchers suggest incentives for innovation.

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Merger creates one of largest nonprofit health care systems in nation

4 months ago

Memphis’ Baptist Memorial Health Care Corp. has completed a merger with Jackson’s Mississippi Baptist Health Systems, creating a $2.5 billion organization and one of the largest not-for-profit health care systems in the country.

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Biogen CEO eyes value-based payer deals to boost pressured MS franchise

4 months ago

Facing stepped-up competition for its critical multiple sclerosis business, Biogen CEO Michel Vounatsos contends his company is “ready and well-equipped” to forge ahead. And that includes “value-based and innovative contracting” with payers, the helmsman told analysts on Tuesday.

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Patient-Centered Medical Home Benefits Payers, Providers, Patients

4 months ago

The patient-centered medical home (PCMH) model brings clinical benefits to patients as well as financial rewards for payers and providers.

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Value-based Payment Models in Oncology: Will They Help or Hinder Patient Access to New Treatments?

4 months ago

Early signs of success in Oncology Value-based Payment Models point to increasing experimentation with these new reimbursement approaches.

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Insurers View All →

Cigna’s Value-Based Approach To Opioid Abuse Makes Progress

3 months ago

Health insurer Cigna says its value-based approach to addiction medicine is making progress, helping curb the misuse and related abuse of opioids.

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Humana Expands Orthopedic Bundled Payment Program to NC, VA

3 months ago

Eleven providers in North Carolina and Virginia will join Humana’s growing orthopedic bundled payment program.

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Molina Healthcare board fires CEO, CFO after poor financial performance

4 months ago

J. Mario Molina, John C. Molina will continue to serve as directors on the board.

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Anthem Blue Cross Nears 60% Value-Based Care Spend

4 months ago

Anthem’s top executive says the health insurer is paying out 58% of its reimbursements via value-based care models that are quickly dominating the U.S. medical system.

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Express Scripts says likely to lose top client Anthem

4 months ago

Pharmacy benefit manager Express Scripts Holding Co said Anthem Inc, its biggest customer and one that has sued the company over claims of being overcharged, was unlikely to renew its contract after it ends in 2019.

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