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State Exchanges View All →

United Healthcare to Expand Presence in ACA Health Insurance Exchanges

1 week ago

Last week, United Healthcare (UnitedHealth Group, UHN), announced it would expand into the Health Insurance Exchanges (“Marketplaces”) in as many as 24 states in 2015, up from only five this year.

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Hospitals, Insurers Say Subsidies Rulings Further Confuse the Issue

1 week ago

Health-industry officials said Tuesday’s dueling court rulings over federal health-law subsidies set the stage for another bout of confusion as consumers return to marketplaces this fall to shop for next year’s coverage.

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Federal Appeals Court Delivers Serious Setback To Obama Health Care Law

1 week ago

A federal appeals court delivered a serious setback to President Barack Obama’s health care law Tuesday, potentially derailing billions of dollars in subsidies for many low- and middle-income people who bought policies.

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ObamaCare subsidies in jeopardy

1 week ago

A pillar of ObamaCare was put in jeopardy Tuesday as two appeals courts split on whether the law’s premium subsidies are legal in 36 states.

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Specialty Care Is A Challenge In Some ACA Plans

2 weeks ago

Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace.

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Medicaid View All →

Many dual-eligibles opt out of care coordination

1 week ago

People who are eligible for both Medicare and Medicaid are opting out at high rates from voluntary state initiatives aimed at better coordinating their care.

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Hospitals See Troubles In Red States That Snubbed Obamacare’s Medicaid Deal

2 weeks ago

While record numbers of Americans sign up for the larger Medicaid health insurance program for the poor, financial issues are emerging for medical care providers in the two dozen states that didn’t go along with the expansion under the Affordable Care Act.

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The Medicaid Boom And State Budgets: How Federal Waivers Are Advancing State Flexibility

2 weeks ago

Due to political tensions, some states are seeking waiver approval from the Secretary to expand Medicaid, but in a way that they believe better serves their population.

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Medicaid can reap the rewards of medical homes

2 weeks ago

Medicaid programs could lower costs and boost quality care by implementing a patient-centered medical home model.

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Medicaid Adds Another Million Enrollees In May

3 weeks ago

While enrollment in private health insurance through online marketplaces may be closed until Nov. 15, Medicaid and the Children’s Health Insurance Program added almost a million new patients in May, according to the Centers for Medicare and Medicaid Services.

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Emerging Healthcare Models View All →

Michigan Blues medical homes create dramatic savings

3 days ago

A transformation of care statewide” is underway as 1,422 physician practices, comprising of 4,022 primary care physicians, are now operating within Patient-Centered Medical Homes.

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130 million patients will receive accountable care by 2017

7 days ago

Accountable care organizations (ACOs) and value-based purchasing arrangements will be responsible for the care of 130 million patients by 2017, predicts a report by Parks Associates.

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When Hospitals Buy Clinics, Prices Go Up

1 week ago

By turning what used to be independent medical offices into so-called hospital outpatient centers, hospitals are creating networks that, critics say, give them the power to set prices and ultimately raise costs for private insurers and government programs such as Medicare.

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University Hospitals, Aetna form accountable care organization (ACO) in Cleveland

2 weeks ago

University Hospitals and Aetna, the third largest U.S. health insurer, have launched an accountable care organization collaboration (ACO) designed to coordinate care and reduce costs for participants enrolled in the insurer’s health plans.

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UnitedHealthcare teams up with accountable care organization

2 weeks ago

Summit-based Optimus Healthcare Partners, an accountable care organization, and the health insurer UnitedHealthcare announced Wednesday they are working together to provide coordinated health care.

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Insurers View All →

A Health Trade-Off That’s Here to Stay: Lower Cost, Limited Choice

3 days ago

By changing the rules, the Affordable Care Act pushed health insurers toward a new strategy: limiting the choice of doctors and hospitals they’ll pay for. That move helped insurance companies keep premiums low despite all the new restrictions, but they’re inspiring resistance.

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Insurers to refund $330M in premiums as result of Affordable Care Act

1 week ago

Insurers will refund about $330 million in premiums to 6.8 million consumers across the country in the coming weeks as a result of the Affordable Care Act.

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Tug-of-war develops over essential benefits

1 week ago

Starting this year, all insurers must provide certain essential health benefits as required under the Affordable Care Act. However, business groups are calling for restructured benefits while consumer advocates are pushing to uphold the coverage requirements.

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To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks

2 weeks ago

The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills.

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Insurers push for change to medical-loss ratio

2 weeks ago

The health insurance industry is urging lawmakers to amend the Affordable Care Act’s medical-loss ratio provision-it wants payments to brokers and agents excluded from administrative costs.

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