News

UnitedHealth: 3 ways to better engage members

UnitedHealthcare is focusing on three main areas to meet the ongoing demands of its customers. In an article for Healthcare Payer News, UnitedHealth's Chief Consumer Officer Tom Paul recommends health insurers do the following.

Provider network complaints flood insurers

While policies with limited networks of doctors and hospitals existed before the Affordable Care Act, the backlash has been growing against narrow networks since exchange coverage kicked in.

ACA architect claims law forced states to build exchanges

Jonathan Gruber, a professor at Massachusetts Institute of Technology who advised the Obama administration when developing the Affordable Care Act in 2009, claimed the federal government would not help states that did not create their own exchanges to politically pressure them to do so.

States want to use health reform funds in 2015

Due to constantly changing technical requirements and demands from the Obama administration, states running their own exchanges want more time to spend their federal dollars, reports PoliticoPro.

Is bigger better in healthcare?

I'm a fan of the mom-and-pop store. Even if it means paying a little more for the same product available at a big-box retailer, I would prefer shopping at a small, local store. That's because I tend to receive better customer service at the smaller shops where they personally value my business. And I would allege the same to be true in the healthcare industry.

Palliative care coverage: Connecting the dots

FierceHealthPayer spoke with Torrie Fields (pictured), Cambia's program director for serious illness and palliative care. She describes the specifics behind Cambia's palliative care program, which began July 1 and is available to its more than 2 million members, and how it helps members have the difficult conversations around end-of-life care.

Cambia Health CEO Mark Ganz on the cutting edge of end-of-life care

To learn more about Cambia's palliative care program, which facilitates members' healthcare needs from wellness through completion of life, FierceHealthPayer spoke with Cambia CEO Mark Ganz in an exclusive interview.

Insurers must find the path to data mastery

As data takes on an increasingly important role in healthcare, insurers need to leverage their data as a strategic asset aligned with business goals, according to Insurance & Technology.

Former CMS head talks accountable care ROI

Both payers and providers can reap financial returns from ACO efforts, former Centers for Medicare & Medicaid Services Administrator and current Director of the Health Care Innovation and Value Initiative at the Brookings Institution Mark McClellan, M.D., Ph.D., told AAFP News.

Republican lawmakers blast Medicare Advantage cuts

Republicans claim the Obama administration is "masking" Medicare Advatage cuts now to avoid making voters angry in an election year, according to The Hill.

Young adults not as crucial to reform success

Opinions vary regarding the belief that enrolling young adults may determine reform success. On one hand, experts believe that the number of young adult sign-ups and the male-to-female ratio will determine success. On the other hand, some say that having more young, healthy people purchasing healthcare is not as crucial as people think, according to an opinion piece published by Philly.com.

Insurers worry ACA loophole could lead to unpaid premiums, bad debt

Thanks to a loophole in the Affordable Care Act regulations, insurers worry customers who purchased plans on the federal marketplace could evade paying their December premiums, reports Vox.

Consumers continue to flock to HealthCare.gov

Open enrollment has come and gone but new federal data, obtained by ProPublica, shows the federal exchange saw roughly 1 million insurance transactions since mid-April.

MLR rebates total $9B

Insurers have paid consumers a total of $9 billion since 2011 under the medical-loss ratio, the U.S. Department of Health and Human Services announced today.

Cut prescription drug prices to achieve Medicare savings

Given the recent surge in pricey prescription drugs, lawmakers are calling for Medicare to offer rebates and negotiate prices to reap significant savings, according to a report released Wednesday by advocacy groups the Medicare Rights Center and Social Security Works.

Subsidy rulings mean more enrollment work for insurers

Given the opposing opinions coming out of two separate court rulings regarding Affordable Care Act subsidies, there's bound to be confusion among consumers interested in signing up for coverage during the next enrollment period.

How payers can eliminate consequences of provider consolidation

Although insurers and industry organizations often assert that provider consolidation leads to higher prices, some experts believe the impact is relatively neutral, reported Insurance News Net.

GAO: Fake ACA applicants secure subsidized coverage

Government investigators have been able to purchase health plans and obtain federal subsidies using fake applicantions, according to findings that will be released today, reports The Washington Post.

Tug-of-war develops over essential benefits

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, Kaiser Health News reported.

States on board with HSAs for Medicaid

Some states may implement health savings accounts (HSA) for their Medicaid programs next year, reports NPR.  Michigan and Indiana already allow beneficiaries to use funds supplemented by the state to pay for services and require monthly contributions to their health independence accounts.