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3 ways payer-led ACOs achieve the triple aim

By Dori Zweig Accountable care organizations (ACOs) have the power to transform the healthcare industry. But in order to do so, they must achieve the triple aim: reduce costs, increase efficiency and...

Highmark vs. UPMC: The saga continues

"It's like fourth grade," Judge Dan Pellegrini said of a court hearing Wednesday regarding the ongoing dispute between Pittsburgh health giants Highmark and the University of Pittsburgh Medical Center.

Blues plans' success could be hurting their bottom lines

In 12 of the 15 states with exchange information available, Blues plans dominated the marketplaces last year. The plans' success stems from competitive market share, sound customer service and active participation with government programs. But to compete in today's healthcare insurance market, playing it safe doesn't cut it, Bill Copeland, U.S. leader of Deloitte's life sciences and healthcare practice told FierceHealthPayer in an exclusive interview this morning.

Humana considering sale of Concentra

Humana is considering selling Concentra, its provider subsidiary that is valued at about $1 billion, three people familiar with the matter told Reuters.

Price transparency leads to lower claims costs, research finds

When consumers have access to pricing information before they obtain medical services, insurers' claims payments are lower, according to new research published in the Journal of the American Medical Association.

Insurers can cancel exchange plans if subsidies ruled illegal

Insurers that sell plans on the federal health insurance exchange can cancel the policies if the Affordable Care Act subsidies are ruled illegal. The Centers for Medicare & Medicaid Services added the opt-out clause to 2015 contracts that insurers must sign to sell on HealthCare.gov

Companies scheme to get out of paying hefty ACA fines

Many companies are devising schemes to get out of paying hefty fines next year for not complying with the Affordable Care Act's mandate to offer health insurance, reports the Wall Street Journal.

Survey: Docs report rocky relationship with payers

Doctors facing a changing practice environment are unhappy with most large health payers, according to the 2014 Medscape insurer ratings report.

Medicare spending slowdown: Thank Part D

Medicare spending is slowing down drastically--thanks, for the most part, to Part D. The Medicare prescription drug program has accounted for more than 60 percent of Medicare spending cuts since 2011, according to a Health Affairs blog post.

Do state officials have authority over Medicare Advantage insurers?

As Pennsylvania officials have attempted to force Highmark into expanding its Medicare Advantage network, Highmark pushed back by claiming that the state lacks authority over the federal program.

RWJF: Essential benefit requirements vary widely among states

States require insurers to include a wide array of essential health benefits in their plans, making it challenging for insurers to sell plans across state lines, according to a new report from the Robert Wood Johnson Foundation.

Rand: Subsidies and individual mandate serve as 'carrot and stick' for ACA success

Removing tax credits that help low- and moderate-income people buy health insurance on exchanges would increase premiums by nearly 45 percent, according to results of a Rand Corp. study. More than 11 million Americans would lose coverage. 

Documents reveal health insurance funding gap in Mass.

In Massachusetts, confidential drafty documents reveal a $415 million gap between the state and federal government's health insurance spending expectations, reports Boston Business Journal.

Aetna helps members address emotional impacts of cancer

Aetna has launched a new pilot program that aims to help its members address the emotional impacts of cancer in addition to all the physical issues. The program, called Aetna CarePal, connects members who have recently been diagnosed with breast cancer to members who have already survived the disease, the insurer said yesterday in an article on its website.

Will high deductibles cost insurers more money?

The rise in plans sold on health insurance exchanges with high deductibles brings a new concern--consumers who postpone needed care because of the cost. Those decisions could mean the high-deductible health plans backfire on insurers and could lead to even more medical use and greater expenses in the future, The New York Times reported.

Best practices for payer health management programs

Health IT tools and more transparent relationships with providers are among the best practices that can help health insurance companies improve health management programs, according to a new report by IDC Health Insights.

Stanford professor predicts doom for health insurers

Competition among health systems and pressure to cut costs will transform--if not doom--health insurance companies in their current form, Stanford University Professor Jeffrey Pfeffer argues in a Fortune article. 

SHOP exchanges face sluggish adoption, technical glitches

The Small Business Health Options Program (SHOP) exchanges were meant to drive down costs and boost enrollment. But the program, part of the Affordable Care Act, has yet to reap anticipated rewards.

Let's address the dark side of Medicare Advantage plans

Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well.

In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have.

This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.

Horizon expands patient-centered care programs

Horizon Blue Cross Blue Shield of New Jersey is expanding its patient-centered practices to its newest Medicare Advantage plan.