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State Exchanges View All →

Cancer hospitals participating in at least some exchange plan networks

1 day ago

Most specialized cancer hospitals say they participate in the narrow provider networks of some exchange health plans, but health insurers have not been shy keeping some cancer hospitals out, according to a new survey from consulting firm Avalere Health.

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Challenges Facing “Narrow” Provider Networks on the ACA Health Care Insurance Exchanges

2 days ago

The Driving Forces Behind the Trend Toward Narrower Networks.

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5 states where PPACA exchange silver plan costs soared

1 month ago

Active bargain hunters who were willing to change health plans could get good prices for coverage from the typical Patient Protection and Affordable Care Act public exchange-except in 5 states.

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HHS: More Than 1M Exchange Enrollees Chose New Plans for 2015

1 month ago

More than one million U.S. residents who signed up for exchange plans this year selected new coverage, which the Obama administration said could help to keep down premium costs.

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Insurers’ Drug Tiering Can Keep Sickest Patients Away

3 months 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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Medicaid View All →

Economy boosts safety-net hospitals in states not expanding Medicaid

2 months ago

Hospitals that treat many poor and uninsured patients were expected to face tough financial times in states that did not expand Medicaid under the Affordable Care Act.  But in some of the largest states that did not expand Medicaid, many “safety net” hospitals fared pretty well last year — better than in 2013 in many […]

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More States Lean Toward Medicaid Expansion

3 months 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

3 months 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

3 months 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

4 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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Emerging Healthcare Models View All →

Health Insurance Shoppers Look to Limited Networks to Save Money

1 week ago

In all the turmoil in health care, one surprising truth is emerging: Consumers seem increasingly comfortable trading a greater choice of hospitals or doctors for a health plan that costs significantly less money.

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Are State Innovation Waivers the Future of Health Care Reform?

3 weeks ago

Beginning in 2017, states will be able to apply for waivers for flexibility in implementing many of the Affordable Care Act’s key requirements — an opportunity that some see as a catalyst for health reform.

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New tiered health network coming to New England

3 weeks ago

Lifespan, the largest health system in Rhode Island, and Tufts Health Plan are launching a tiered provider network, an approach that executives believe will control healthcare costs.

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A Medicaid ACO?

1 month ago

Medicare ACOs-would such a model work for Medicaid?

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The Affordable Care Act CO-OP Program: Facing Both Barriers and Opportunities for More Competitive Health Insurance Markets

1 month ago

The failure of the health insurance CO-OP operating in Iowa and Nebraska and recent analysis documenting significant losses among all but one CO-OP have caught the attention of policymakers and raised questions about the long-term viability of the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program.

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Insurers View All →

Here’s why carriers are forced to sink or swim in a post-PPACA market

2 weeks ago

The traditional healthcare business is fading into the sunset, along with its complex product structures, incomprehensible reimbursement models, and confusing industry jargon. A new day is dawning, and opportunities abound for the players that are prepared to pursue them.

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Insurers show greater compliance with medical loss ratio

4 weeks ago

Rebates that insurers owe patients are dropping, Commonwealth Fund finds

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Employers Warm To Obamacare, Stick With Coverage

4 weeks ago

Five years after employers were considering terminating health coverage due to costs and other issues related to the Affordable Care Act, companies have largely changed their tune as fears have not been realized, according to a new analysis.

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Implementing Health Reform: Wraparound Benefits Final Rule; Coverage Report

1 month ago

With open enrollment closed for 2015 and the Departments having finalized the Benefit and Payment Parameters Rule and Letter to Issuers for 2016, we have entered the Spring Affordable Care Act regulatory doldrums.  This post addresses the final wraparound coverage excepted benefits rule, and a report on health insurance coverage and the ACA (technical appendix here), […]

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Rethink the link between insurance premiums and wellness programs

2 months ago

Wellness programs that track physical activity and use incentives to reward progress are seen as a novel way to make health insurance pricing more equitable, but there is a fine line between rewarding personal responsibility and discriminatory pricing schemes.

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