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State Exchanges View All →

United Healthcare to Expand Presence in ACA Health Insurance Exchanges

2 days 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

2 days 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

2 days 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

4 days 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

1 week 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

3 days 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

5 days 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

1 week 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

1 week 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

2 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 →

130 million patients will receive accountable care by 2017

1 min 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 day 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

7 days 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

1 week 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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CVS Caremark Announces New Clinical Affiliations with Four Major Health Care Providers

1 week ago

Clinical collaboration with CVS/pharmacy and MinuteClinic will increase access to care and help improve medication adherence for patients.

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Insurers View All →

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

1 day 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

2 days 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

6 days 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

1 week 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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Early Effects of Medical Loss Ratio Requirements and Rebates on Insurers and Enrollees

2 weeks ago

  More than three quarters of insurers met or exceeded Medical Loss Ratio standards in 2011 and in 2012, and the median MLRs among all insurers was 88 percent.

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