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State Exchanges View All →

CMS Sees No 2015 Risk Corridor Payouts But Contemplates Settling Insurer Lawsuits

2 weeks ago

Although it has not yet completed review of QHP insurer risk corridor submissions, it has preliminarily concluded 2015 payments will again result in a shortfall.

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Insurers Move to Limit Options in Health-Care Exchange Plans

3 weeks ago

Losses on Affordable Care Act exchanges spur narrower choice of doctors, hospitals.

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Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces

3 weeks ago

A preliminary picture of the potential effect insurer exits and entrants may have on competition and consumer choice in the Affordable Care Act (ACA) marketplaces.

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Health Insurers’ Pullback Threatens to Create Monopolies

3 weeks ago

Analysis suggests ACA exchanges are likely to offer just one coverage option in 31% of U.S. counties.

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Changes to ACA exchanges may be enough to keep them afloat for now

3 weeks ago

Proposed changes to help stabilize the Affordable Care Act health insurance exchange markets should be enough to stop the bleeding, but further changes will likely be needed next year.

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

Medicaid View All →

Molina uses narrow networks to make money on ACA

3 days ago

Molina’s experience selling plans within a government framework prepared it for the ACA landscape. 

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Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA

4 days ago

With three years of expanded coverage under the ACA in place, many states have shifted focus from outreach and enrollment to strengthening delivery systems and enhancing access to care to meet the needs of their growing covered populations.

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Medicaid ACOs: The Quietly Rising Tide of Value-Based Care

2 months ago

Medicare ACOs, which come in a variety of programs—Medicare Shared Savings, Pioneer, and Next Generation have justifiably attracted the most attention and scrutiny, as Medicare constitutes the biggest area of healthcare spending by the federal government.  But there is another significant and growing area of healthcare spending that is undergoing a less visible (but just […]

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CMS dual-eligible demos called into question

2 months ago

Despite a recent report stating that CMS needs to do a better job overseeing the 13 state-administered dual-eligible demonstration programs, some stakeholders say the initiative is on the right track.

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State medical home initiative slashes healthcare costs for complex Medicaid patients

3 months ago

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

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Emerging Healthcare Models View All →

The Growth of Medical Homes in New York State, 2014 to 2016

2 days ago

New York State continues to lead the nation in adoption of the medical home model by primary care practices, according to the newest in a series of reports tracking medical home growth in New York State.

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Oncology Medical Homes Are Proving Their Mettle and Worth

3 days ago

The oncology medical home (OMH) practice model, in which the patient has a central coordinator for all of his or her care, is proving to be a viable and sustainable business option.

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18 hospitals and health systems with unique population health initiatives

2 weeks ago

Here are 18 population health programs from hospitals and health systems. The hospitals have reported success in achieving their goals and creating healthier communities.

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Horizon Blue Cross pays doctors $58.9 million for improving care

2 weeks ago

Horizon Blue Cross Blue Shield of New Jersey, the largest insurer in the state, said it paid doctors $58.9 million in care coordination and quality bonuses last year, up from $40.4 million in 2014.

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Surge in hospital-owned physician practices poised to increase healthcare costs

2 weeks ago

Independent physicians and physician-owned practices could soon become a rare breed.

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Insurers View All →

Insurers, PBMs take heat for reaction to rising drug costs

2 weeks ago

Similar to the much-maligned pharmaceutical companies, health insurers are increasingly becoming the target of consumer backlash over the rising cost of drugs.

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Insurance Startup Oscar Quits Two Markets, Rethinks Obamacare Plans

1 month ago

Health insurance startup Oscar Insurance Corp. will reevaluate its approach to Obamacare after suffering significant losses under the U.S. program and will pull out of two markets next year.

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Employers Slowly Adopt Value-Based Health Benefit Designs

1 month ago

Employer adoption of value-based health plan designs, which encourage workers to go to quality doctors and hospitals and work to limit overuse of medical services, is slowly taking hold.

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How Obamacare Costs Are Hammering Insurers

2 months ago

Health insurance companies that used to be bullish on the Affordable Care Act now say they cannot handle the mounting medical claims of the people they once so desired as customers.

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UnitedHealth Pays $148M In Bonuses As Value-Based Care Tightens Grip

2 months ago

  UnitedHealth Group said it paid out more than $148 million in bonus payments to primary care doctors last year for their efforts to improve health outcomes for seniors in the company’s Medicare Advantage plans.

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