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State Exchanges View All →

HHS says 2017 ACA plans will still be affordable despite insurer exits

2 days ago

The Obama administration is fighting the notion that recent bad news for the Affordable Care Act marketplaces, including multiple insurers pulling out and reports of skyrocketing premium rates, will sink the exchanges.

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One-third of states have little to no competition on the Obamacare exchange markets

2 days ago

Alaska, Alabama, Kansas, North Carolina, Oklahoma, South Carolina and Wyoming, will have only one carrier per region.

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Aetna Joins Other Major Insurers In Pulling Back from Obamacare

1 week ago

Health insurer Aetna Inc. will stop selling individual Obamacare plans next year in 11 of the 15 states where it had been participating in the program, joining other major insurers that have pulled out of the government-run markets in the face of mounting losses.

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Co-ops New Mexico Health Connections & Minuteman Health of Massachusetts file suits against ACA’s risk-corridor program

3 weeks ago

After suffering hefty losses, two more co-ops are filing lawsuits against the Obama administration over the Affordable Care Act’s risk-corridor program.

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Aetna’s exchange woes stoke worries about ACA marketplaces

3 weeks ago

Aetna’s announcement that it will reconsider its participation in some Affordable Care Act marketplaces has amplified concerns about the long-term viability of the exchanges.

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Medicaid View All →

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

3 weeks 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

4 weeks 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

2 months 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

2 months 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

3 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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Emerging Healthcare Models View All →

CMS selects markets for new primary-care payment initiative

3 weeks ago

The CMS will launch an ambitious primary-care quality improvement initiative in 14 regions, including 11 whole states. The states include Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.

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

1 month 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

1 month 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

2 months 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%

2 months 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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Insurers View All →

Insurance Startup Oscar Quits Two Markets, Rethinks Obamacare Plans

2 days 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

2 days 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 weeks 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

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

1 month 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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