Brokers still play major role in industry but need better tools to assist consumers CEO Kevin Counihan believes brokers still play a pivotal role in a post-Affordable Care Act health insurance industry CEO on hot seat for withholding enrollment data

Kevin Counihan, CEO of, was on the hot seat in front of a Congressional committee hearing Thursday.

Opportunities for Medicare Advantage plans amid rate cut proposal

The Centers for Medicare & Medicaid Services raised eyebrows when it proposed lower Medicare Advantage reimbursement rates for 2016, but the proposal isn't all bad news for Medicare Advantage plans.

Report: Account-based health plans on the rise, but obstacles remain

Eighty-seven percent of healthcare industry professionals believe account-based health plans (ABHPs) are important to their business, according to a new study from health plan software-as-a-service vendor Acclaris.

As Medicaid enrollment grows, participating doctors decreases

As Medicaid enrollment continues to rise--it now covers as many as 1 in 5 Americans--the number of primary care physicians accepting Medicaid is dropping. Just 34 percent of PCPs now accept Medicaid, which is a 9-point drop from two years ago.

King v. Burwell: Implications of federalism could save Obama administration's case

With one week to go until the Supreme Court hears oral arguments regarding the federal subsidies case of King v. Burwell, the tug-of-war between the Obama administration and opponents of the Affordable Care Act rages on. But a new argument has surfaced that could be the saving grace for the administration.

Health Care Cost Institute price transparency site goes live

The Health Care Cost Institute has launched a website listing cost information for more than 70 common health conditions and services based on claims data from four major insurers.

Ascension Health getting into insurance game

Ascension Care Management LLC, the population health unit of Ascension Health, the nation's largest nonprofit and Catholic health system, has spent $50 million to acquire Michigan-based...

4 creative ways to reach customers amid qualifying life events

Payers need to get creative in order to reach customers who need insurance outside of the typical open enrollment period, according to a recent report from the Robert Wood Johnson Foundation.

State exchanges must focus on design to better inform consumers

With two open enrollment periods behind us--for the most part--it's time to focus on how an exchange's website design factors into a consumer's choice.

OIG to investigate subsidies, security of insurance exchanges

The Office of Inspector General is planning to beef up its oversight of the Affordable Care Act, keeping a close eye on subsidies and how the U.S. Department of Health & Human Services protects individuals' personal information, according to an OIG report.

Kaiser Permanente removes HIV/AIDS drugs from highest tier

Effective Jan. 1, 2015, Kaiser Permanente had classified many HIV/AIDS medications as specialty drugs, which required members to pay a 20 percent co-insurance fee each time the prescription was filled. Last week, Kaiser reversed this decision.

How payers can speed up the claims process

The slow claims processing cycle makes it difficult for payers to identify high-risk patients. To obtain better access to data, Healthcare IT News offers three suggestions for payers. 

Burwell: There's no backup plan in subsidies case

There is no backup plan to prevent millions from losing their health insurance if the Supreme Court decides to overturn a key provision of the Affordable Care Act that allows federal tax subsidies for health insurance, Health and Human Services Secretary Sylvia Mathews Burwell stated in a letter to lawmakers.

Could comprehensive primary care decrease ER use in Medicaid population?

Although almost 25 state programs employ higher copays for emergency department visits in an effort to decrease ED use, charging more when Medicaid recipients go to the ED may not be effective.

Humana to integrate Weight Watchers programs into employer-sponsored plans

Humana is aiming to help lower the obesity rate by partnering with Weight Watchers, giving its members with employer-sponsored plans access to Weight Watchers weight loss programs that are integrated within Humana's own wellness program.

Startup brings patients into claims processing

Healthcare fraud, waste and abuse costs the United States as much as $270 billion annually. A Philadelphia-based startup called TrueClaim thinks it has found a solution to combat this spending issue by bringing patients into the claims reconciliation process.

Arkansas, Kentucky leading states for reduced uninsured rate

Arkansas and Kentucky are sitting pretty when it comes to reducing their uninsured rates. From 2013 to 2014, Arkansas experienced a 11.1 percent drop, while Kentucky saw a 10.6 percent drop, according to a new Gallup poll.

Report: Payer business process outsourcing market growing steadily

The healthcare payer business process outsourcing market grew at a rate of 14 percent in 2013 and is likely to continue growing at that rate over the next few years.

Medicare Advantage rate cut would reduce payer funding

The Centers for Medicare & Medicaid Services claim that its proposal to cut Medicare Advantage reimbursement rates by 0.95 percent in 2016 will not impact insurers' revenue, but industry experts say the changes will hit their bottom lines.