Aegis Health Group CEO: Dramatic changes ahead for health insurance industry

Hold on to your seats and gear up for the most dramatic changes the health insurance industry has faced yet, says Aegis Health Group CEO Phil Suiter, in an exclusive interview with The Tennessean. 

Anthem Blue Cross slammed with narrow-network lawsuit

As the healthcare industry as a whole is moving toward a more consumer-centric mindset, this does not bode well for insurers who offer a list of only narrow-network providers.

Some states want more authority over Medicare Advantage

Some state officials want more regulatory authority over Medicare Advantage plans. Right now, state regulators can't impose sanctions on Medicare Advantage plans; only the Centers for Medicare & Medicaid Services has that power.

Report: Copper exchange plans would save billions

Insurers hoping to have the option of selling a new plan on the health insurance exchanges just got a boost for their cause: The so-called "copper plans" could reduce federal healthcare spending by $5.8 billion over the next 10 years, according to an analysis released Tuesday from Avalere Health.

Innovation is key to wellness program success

Thinking outside of the box has helped two wellness programs achieve success, including lowering claims costs and helping participants lose weight.

Competition sparks payer-provider divorce

The Affordable Care Act is sparking competition among healthcare insurers and providers, as insurers make moves to become healthcare providers, reports NPR.

5 complex care management methods to boost ACO success

​Accountable care organizations often involve high-need, high-cost patients, which can make for a very expensive and challenging program to manage. But a team of researchers has identified effective ACOs that successfully implement complex care management (CCM) interventions that insurers and providers can use to bolster their own programs, lower costs and improve care.

Covering all preventive tests leads to higher utilization, costs

As insurers are covering more preventive tests and screening, as required by the Affordable Care Act, two financial experts question whether such coverage actually incurs additional costs for the companies.

More young adults receiving mental health treatment

More young adults have been receiving treatment for mental health conditions since the ACA allowed them to remain on their parents' plans until they turn 26 years old.

For-profit insurers will diversify into data market, industry watchdog predicts

Non-profit insurers will soon be the dominating type of insurance company due to competition fostered by the Affordable Care Act, says industry watchdog Wendell Potter. If for-profit insurers want to remain viable in the post-ACA market, the former Cigna exec says they must diversify by operating outside the United States and expanding their business lines.

Coordination of care to be reimbursable

Amid growing evidence that patients with chronic illnesses suffer from disjointed, fragmented care, the Obama administration is planning to pay doctors to coordinate the care of Medicare...

ACA legal challenges could cause trouble for states on federal exchange

A new analysis shows healthcare payers may face a rocky road as recent legal battles continue to brew over ACA subsidies.

Prescription drug tiers can't handle all budget woes, study shows

Over the years, insurers have tried--with varying degrees of success--to rein in prices and moderate the costs of prescription drugs. But to ensure consumers can afford speciality tier drugs, a new issue brief from the Robert Wood Johnson foundation recommends payers team up with state and federal regulators to combat the soaring prices.

Top 10 insurers in the Part D arena: UnitedHealth at the top

UnitedHealth is top dog when it comes to Medicare Part D presence in the U.S. health insurance market, according to a new study from the Kaiser Family Foundation.

Discrimination accusations plague insurers

Implementation of the Affordable Care Act was meant to stop insurers from discrimination against consumers with pre-existing or expensive-to-treat conditions. Yet many critics worry new barriers from healthcare insurers continually lead to certain bias, reports the Associated Press.

Blue Shield, Anthem of California bring health insurance into the 21st century

It's nice to see competitors working together for the good of the consumer. That's exactly what two of California's biggest insurers--Blue Shield of California and Anthem Blue Cross--did...

Top Blues execs in Alabama receive million-dollar pay increases

Top 10 executives at Blue Cross and Blue Shield of Alabama earned an additional $1 million each in 2013, and collectively have doubled their pay since 2011, according to an article on


Majority of voters continue to oppose ACA

For the past year, opposition to the Affordable Care Act--implemented back in 2010--has been above 50 percent. Once again, according to the latest Fox News poll, this continues to be true.

Pricey compounded drugs come under scrutiny

What does a $1,600 custom-made diaper rash treatment, $8,500 scar-reduction cream and a $2,300 pain-relieving salve all have in common? Their price tag, and more often than not, healthcare insurers are left to pick up the expensive bill for compounded medicines, reports the New York Times.

Challenges plague upcoming enrollment period

Despite providing coverage to more than 10 million previously uninsured Americans, the Affordable Care Act will face hurdles once November rolls around, reports the Huffington Post.