News

Over 1 million people enrolled in health insurance CO-OPs in 2015

As of March 25, over 1 million people enrolled in consumer operated and oriented health insurance plans during the 2015 enrollment period, the National Alliance of State Health CO-OPs announced.

UnitedHealth-Catamaran deal all about negotiating better drug prices

UnitedHealth's $12.8 billion acquisition of pharmacy benefit manager Catamaran is all about combatting high drug prices, the Washington Post reported.

Health plans need to up their game to help smokers quit

A majority of state health insurance marketplace plans do not do enough to provide smokers with the assistance they need to quit, according to a new report from the American Lung Association.

GAO: CHIP plans better than ACA qualified health plans

With CHIP funding set to expire on Sept. 30 unless Congress acts, the GAO examined data from five states to determine whether CHIP plans are comparable to QHPs. The GAO reviewed coverage and costs to consumers for one CHIP plan and one QHP in Colorado, Illinois, Kansas, New York and Utah.

How payers, providers make bundled payments work [Special Report]

This FierceHealthPayer special report explains the basics of bundled payment agreements, identifies some of the most successful use cases for bundled payments, examines the positive impact that bundled payments can have on care delivery and discusses what it will take for bundled payments to spread beyond today's use cases.

New York Medicaid tests pay-for-performance method that pairs competing providers

New York state Medicaid officials are investing more than $1 billion in an innovative five-year program that aims to transform how providers coordinate to take a more active role in caring for members' health while also compelling patients to improve their health.

UnitedHealth balance billing change could hit consumers with unexpected big bills

Minnesota-based UnitedHealth has changed its balance billing practice. In an effort to drive down costs, the insurer will not cover the entirety of bills for out-of-network emergency room physicians and specialists even though they sometimes work for hospitals in UnitedHealth's network.

5 factors will shape what happens to ACA in next 5 years

The Affordable Care Act faced hurdles and achieved milestones in its first five years. Now that its anniversary has passed, attention turns to what's in store for the future of healthcare reform.

Senate passes two health insurance amendments, files a third

The Senate actually got something done last week. Senators voted on budget amendments to cut the employer contribution on their own health insurance and to improve health insurance price transparency.

UnitedHealth to buy pharmacy benefit manager Catamaran for $12.8B

UnitedHealth Group Inc. will buy Catamaran Corp. for about $12.8 billion and merge it into OptumRx, its pharmacy benefit service, the company announced today. The deal will likely close in the fourth quarter of 2015.

Blue Shield of California now faces pressure to lower premiums

After losing its tax-exempt status in the state of California and spending more than $1.2 billion to acquire another insurer, Blue Shield of California now faces a debate over its premiums, reported the Los Angeles Times.

Aetna, other payers lower costs of HIV drugs

After facing harsh scrutiny for placing HIV and AIDS prescription drugs in the highest category of cost sharing, insurers are making moves to reduce out-of-pocket costs for these pricey medications.

To fix healthcare, remember the 80/20 rule

Spend enough time in the business world and you're bound to come across the 80/20 rule, which states that 80 percent of an effect comes from 20 percent of a cause. A small group of customers...

Gingrich: GOP won't repeal ACA

Congressional Republicans who claim they want to repeal the Affordable Care Act really don't want to, former House Speaker Newt Gingrich (R-Ga.) said at the 2015 World Health Care Congress this week in the District of Columbia.

Insurers show greater compliance with medical loss ratio

During the first year of the medical loss ratio, insurers paid $1 billion to consumers, according to recent research from the Commonwealth Fund. Rebates dropped to $325 million in 2013, demonstrating an increase in insurer compliance with the rule.

Employers spend more on wellness programs, penalize employees less

As employers increase their spending on employee wellness programs and lessen the penalties for not participating in the programs, do they hinder their overall return on investment? It's hard to say for sure.

Residents of Healthcare.gov states don't want their own exchanges

The majority of voters in the 34 states using Healthcare.gov do not want to see state exchanges if the Supreme Court ruling in King v. Burwell says that the federal exchange cannot sell subsidized plans, according to a recent poll by the Foundation for Government Accountability.

The problem with health insurers' price transparency initiatives

As insurers increasingly disclose their prices to consumers, the movement might be flawed and could potentially backfire. Without context, the recent price transparency initiatives are essentially meaningless.

How Blue Shield of California could redeem itself

Blue Shield of California has had a rough couple of weeks. In light of recent events, Blue Shield's former Director of Public Policy, Michael Johnson, shed light on the drama surrounding the insurer and provided insight into how Blue Shield could pull itself back up. 

Cigna, SCAN join forces to offer group retiree Medicare Advantage plans in California

Cigna and California-based SCAN Health Plan have formed an alliance to provide Medicare Advantage plan benefits to employer clients in California, the insurer recently announced.