News

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. 

With wellness programs, companies search for the keys to worker motivation

Noting the trend toward tying employees' health insurance premiums to their willingness to participate in a wellness program, a Columbus CEO article points to keys to creating successful programs.

Delaware drops Medcaid coverage, job losses likely

Delaware's department of Health and Social Services will stop offering Medicaid coverage through Delaware Physicians Care, an Aetna health plan, reports The News Journal.

Good news: Healthcare spending slowing down, may help GDP

Over the years, healthcare spending has taken up a large portion of the U.S. economy's gross domestic product. Additionally, the U.S.'s proportion of GDP spent on healthcare continues to rise faster than any other developed nation. Yet there is a silver lining: Healthcare spending is slowing down.

Obama administration likely to block plans excluding hospital benefits, sources say

The Obama administration will likely kill an option under the Affordable Care Act that lets large employers offer health plans that exclude hospital benefits, sources told Kaiser Health News.

Bundled payments can be gateway to payment reform

When insurers implement bundled payment projects, they're transforming care by focusing on quality and lowering costs, making it a strong gateway to propel payment reform, according to a report from the Robert Wood Johnson Institute.

Asian Americans face language barriers when purchasing health insurance

Most details regarding how to purchase health insurance are either in English or Spanish. This poses a problem for Asian American consumers who may experience a language barrier when it comes time to enrolling, reports Kaiser Health News.