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State Exchanges View All →

One-third of payers made money on ACA marketplace in 2014

6 days ago

Only about one-third of health insurers came out ahead in the Affordable Care Act marketplace in 2014, according to a study.

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6 strategies the last few co-ops are counting on to survive

2 weeks ago

The remaining co-ops — all posting losses in 2015 — are initiating six survival mechanisms to stay afloat.

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Seven Remaining Obamacare Co-Ops Prepare Survival Strategies

2 weeks ago

New failures are piling up among the member-run health insurance co-ops carrying out one of the Affordable Care Act’s most idealistic goals, leaving just seven remaining when the health law’s fourth enrollment season starts in the fall.

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UnitedHealth to compete in just three ACA exchanges in 2017

2 months ago

UnitedHealthcare, in an effort to cut its losses in the individual market, will only compete in three states’ Affordable Care Act marketplaces in 2017: New York, Nevada and Virginia.

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Aetna Not Withdrawing From Any Health-Law Insurance-Exchange States

3 months ago

Insurer says it may expand into new geographies for exchange health plans.

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Medicaid View All →

State medical home initiative slashes healthcare costs for complex Medicaid patients

4 weeks ago

Integrated, patient-centered care found to be most beneficial for highest risk patients.

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Hospitals Feeling Pinch in States That Don’t Expand Medicaid

1 month ago

While most hospitals have seen a stark decrease in uncompensated care costs related to the Affordable Care Act (ACA) and Medicaid expansion, some hospital groups have not substantially benefited from the change.

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CMS’s Final Rule on Medicaid Managed Care: A Summary of Major Provisions

2 months ago

Major goals of CMS’ in revising the regulations were to align Medicaid and CHIP managed care requirements with other major health coverage programs.

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States save money with new Medicaid policies for incarcerated population

2 months ago

Three states’ initiatives to connect the justice-involved population to Medicaid coverage have produced savings and administrative efficiencies for their Medicaid programs, according to a new issue brief.

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States’ Medicaid demonstrations require robust evaluation

2 months ago

Medicaid expansion waivers carry profound policy implications.

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Emerging Healthcare Models View All →

Anthem Blue Cross of California pilots bundled payments on breast cancer treatment

2 weeks ago

In its first step toward bundled care, Anthem Blue Cross of California has partnered with Valley Radiotherapy Associates Medical Group, an oncology provider in Southern California, to provide an episode-of-care payment option for breast cancer patients.

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As Co-Ops Exit, Obamacare Choices Dwindle For 2017

2 weeks ago

As health insurance companies including UnitedHealth Group soon report third-quarter earnings and cash-strapped co-ops exit the market, it’s becoming more clear what health plans will be offered on public exchanges for 2017.

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Surprise Medical Bills Fuel Fight Between Providers, Insurers

3 weeks ago

‘Narrow network’ plans can deliver shocks when patients inadvertently go outside them for treatment.

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Geisinger Medical Homes For Commercially Insured Consumers Reduced Care Costs By 9%

1 month ago

Commercially insured adults enrolled in a Geisinger Health System patient-centered medical home (PCMH) from 2008 through 2013 had costs of care about 9% lower than costs of consumers not enrolled in a PCMH.

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Aledade rolls out 3 new ACOs, expands another

1 month ago

To ring in its second anniversary, Bethesda, Md.-based Aledade — a company that helps independent physicians participate in value-based care — announced Wednesday three new accountable care organizations and the expansion of another.

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Insurers View All →

Insurers, Pushing for Higher Rates, Challenge Key Component of Health Law

2 weeks ago

For several years, the Obama administration has urged state insurance regulators to use tools provided by the Affordable Care Act to hold down health care premiums.  Now federal officials will have a chance to practice what they preach as they confront big increases proposed in several states where they are responsible for reviewing rates.

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ACA’s risk adjustment hammers small plans again

3 weeks ago

Small, regional health insurers and upstart co-op plans again incurred large charges under the Affordable Care Act’s risk-adjustment program, according to new data by CMS.

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Anthem ACOs save providers $14.8M in one year

3 months ago

Care coordination efforts initiated through Anthem’s accountable care organizations (ACOs) saved four medical groups nearly $15 million over the course of one year.

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Centene profiting from ACA plans, Medicaid expansion

3 months ago

UnitedHealth Group may be abandoning most of the Affordable Care Act’s insurance exchanges due to steep losses. But Centene Corp. is doing just fine in the marketplaces.

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