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State Exchanges View All →

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

2 weeks ago

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

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Humana to exit ACA exchanges in 2 states

3 weeks ago

Humana will not sell Affordable Care Act plans in Alabama and Virginia in 2017.

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Humana Says Obamacare ‘Product Exits’ Coming For 2017

4 weeks ago

Humana said it’s in the process of making several changes to turn the individual health insurance coverage it offers under the Affordable Care Act profitable, including leaving certain states.

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As UnitedHealth Bails On Obamacare, Rivals Look To Expand

4 weeks ago

News that UnitedHealthcare will scale back to just a “handful” of states where the insurer offers subsidized coverage on public exchanges under the Affordable Care Act hasn’t led to a domino effect for the insurance industry.

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As UnitedHealth Bails On Obamacare, Rivals Look To Expand

4 weeks ago

News that UnitedHealth Group will scale back to just a “handful” of states where the insurer offers subsidized coverage on public exchanges under the Affordable Care Act hasn’t led to a domino effect for the insurance industry.

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Medicaid View All →

States’ Medicaid demonstrations require robust evaluation

7 days ago

Medicaid expansion waivers carry profound policy implications.

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Major Medicaid managed-care reforms hand the ball to states. Will they run with it?

4 weeks ago

The key word defining the first significant federal changes to Medicaid managed care in 14 years is “flexibility”—for states, that is.

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85% medical-loss ratio in final managed Medicaid rule

1 month ago

CMS also punted to the states to determine network adequacy.

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The ACA and Medicaid Risk Corridors

1 month ago

The poor results from the Exchanges by United Healthcare stands in stark contrast to the company’s overall profitability-indicating healthy profits from their other books of business, especially Medicaid.

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Rewarding value over volume — not so easy for safety-net hospitals

2 months ago

Safety-net hospitals are uniquely vulnerable under programs that reward and penalize healthcare providers on quality performance. Is there any way to shield their already thin margins from increasing financial pressures?

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Emerging Healthcare Models View All →

The ins and outs of provider-sponsored health plans

2 days ago

Since 2014, the number of provider-run plans has more than doubled, from 107 two years ago to 270 currently in operation today.

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Providers Urge Payers to Reward Value-based Care Models

4 weeks ago

Value-based care is the direction providers must go; finding the right payer partners is the way to get there.

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Evolving stages of population health and ACOs: A comparison of 4 health systems

4 weeks ago

Population health and value-based care delivery is a journey — and every hospital and health system is at a different stage depending on market, payer mix and provider readiness.

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ACOs & Hospitals – The Changing Landscape

4 weeks ago

Currently, two-thirds of Americans live in a geographic area with ACO coverage. That’s a big change in just five years.

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Anthem hatches another hospital joint venture, this time in Wisconsin

1 month ago

Roughly 18 months after Anthem rocked the healthcare business community with a new provider-insurance alliance in California, the health insurer has formulated another similar project. Anthem and Aurora Health Care will co-own a new health insurance company.

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Insurers View All →

Anthem ACOs save providers $14.8M in one year

4 weeks 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

1 month 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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UnitedHealth Quits More Obamacare Markets, Exiting Kentucky

1 month ago

UnitedHealth Group Inc. will pull out of Kentucky’s individual marketplace for Obamacare plans, bringing to 26 the number of states the health insurer is quitting next year.

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Insurers air risk-adjustment concerns in meeting with feds

2 months ago

CMS open to tweaking program, but skeptical of some stakeholder proposals.

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