Follow Health Care Reform Insider on Twitter

State Exchanges View All →

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

2 weeks ago

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

Read More →

CMS adds rule aimed at stabilizing ACA market

1 month ago

The federal government proposed a rule on Wednesday aimed at helping to stabilize the ACA individual and small group insurance markets. 

Read More →

Enrollments Rise on State Health Exchanges

2 months ago

Enrollment increased in a number of state health exchanges for 2017, but it’s unclear if the numbers reflect a response to the expected repeal of the Affordable Care Act.

Read More →

15 things to know about the ACA’s affect on 5 state insurance marketplaces

2 months ago

A study to better understand the ACA’s implementation focuses on competition in California, Florida, Michigan, North Carolina and Texas.

Read More →

48 insurers that decreased their 2017 ACA exchange footprint

2 months ago

48 insurers which sold health insurance on ACA exchanges for 2016 but exited exchanges in some states or markets for the 2017 coverage year.

Read More →

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

Medicaid View All →

Key Themes in Section 1115 Medicaid Expansion Waivers

2 weeks 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 […]

Read More →

3 Key Questions: Section 1115 Medicaid Demonstration Waivers

1 month 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.

Read More →

State Medicaid Programs Invest in Accountable Care Organizations

2 months ago

The number of state Medicaid programs operating accountable care organizations is steadily growing.

Read More →

An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana

2 months ago

Michigan and Indiana are among the seven states using a Section 1115 demonstration waiver to implement Medicaid expansions in ways that differ from the terms of the Affordable Care Act (ACA), although additional states have expressed interest in pursuing similar models.

Read More →

Avoidable Admissions for Long-Term Care Dual Eligibles Down 31%

2 months ago

Preventable hospital admissions for dually-eligible long-term care residents have plummeted thanks to investments in patient safety and value-based care.

Read More →

Emerging Healthcare Models View All →

Private Sector Accountable Care Organization Development: A Qualitative Study

2 weeks ago

Private sector accountable care organization development has been motivated by perceived opportunities to improve quality, efficiency, and population health, and the belief that payment reform is inevitable.

Read More →

Oncology Medical Homes, Patient Navigators Improved Quality and Saved Costs at End of Life

2 weeks ago

Results of a recent study highlighted the medical home and patient navigator models as being associated with significantly lower costs and fewer hospitalizations at the end of life (EOL).

Read More →

65% of Organized Providers Paid Via Alternative Payment Models

4 weeks ago

A recent survey showed that only 35 percent of providers in an integrated employment model are not primarily reimbursed through an alternative payment model.

Read More →

Amgen strikes Enbrel ‘outcomes’ contract with Harvard Pilgrim

1 month ago

Evan as biosimilar competition for Amgen’s blockbuster rheumatoid arthritis drug Enbrel is lurking in the background, the biotech may have found a way to preserve market share with an outcomes-based contract for the popular med. 

Read More →

Harvard Pilgrim bets on value-based drug payments with new deals for Enbrel and Forteo

1 month ago

As high pharmaceutical prices strain budgets of payers and patients alike, Harvard Pilgrim is betting so-called pay-for-performance deals will help lower drug costs and improve patient outcomes. 

Read More →

Insurers View All →

Aetna Gives Up On Merger, Will Pay Humana $1B Breakup Fee

1 month ago

Rather than seek an appeal, Aetna said it will now have to pay Humana $1 billion “as a result of the termination of the merger agreement.” Aetna will also end an agreement to sell certain Medicare Advantage plans to a smaller insurer, Molina Healthcare,  and will pay undisclosed termination fees associated with that deal.

Read More →

Blocked insurer mergers: What the decisions mean and what lies ahead

1 month ago

With both the Aetna-Humana and Anthem-Cigna deals struck down by the federal courts, the implications for both the health insurance industry and antitrust enforcement are just as powerful.

Read More →

Demand For Popular Short-Term Insurance Plans Could Surge If Health Law Is Relaxed

2 months ago

Short-term health plans have been around for decades and after the health law passed, some people gravitated toward them because they were willing to trade comprehensive coverage for a cheaper sticker price — even if it meant paying a tax penalty for not having the comprehensive coverage required in the law.

Read More →

Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

3 months ago

National health insurers are continuing to advance value-based care payment models such as accountable care organizations.

Read More →

MACRA Pushes Payers to Adopt Value-Based Care Payment Models

3 months ago

With providers focused on meeting MACRA regulations, commercial payers are investing in value-based care payment models that align with the quality payment program.

Read More →