News

Payer-provider relationship key to driving value-based care

Experimentation is the name of the game in a vastly complex healthcare industry. Insurers toy with new, innovative payment methods constantly, and all have a similar goal in mind: improve the quality of care while also lowering costs.

Texas struggles with citizenship glitches in ACA healthcare marketplace

Health advocates in Texas are helping the state's minority population overcome language barriers, technical issues and low awareness of who is eligible to obtain health coverage under the Affordable Care Act.

3 steps to a rock solid ACO

As the healthcare landscape continues to evolve and transform the approach to managing patient care, new innovations, such as accountable care organizations (ACO), are success stories. 

California turns up the heat on insurers

California is a brewing hotbed of potential trouble when it comes to insurance rates. California lawmakers propose a state-wide vote on a new ballot initiative that would expand the state's authority to regulate health insurance rates. To make matters worse, voters show signs they support the measure, according to an article in Kaiser Health News.

Aetna to close down its CarePass mobile platform

Aetna is closing the doors of its CarePass mobile platform--a unique mobile approach in the insurance industry that garnered widespread support and collaboration from mobile companies, including FitBit--by the end of the year. It has abandoned all plans for the project.

7M are eligible for health insurance early through exchanges

Insurers should start their outreach and marketing early as there are almost 7 million people who are eligible to enroll in a plan sold on the health insurance exchanges before the next open enrollment period begins on Nov. 15, says a new report from Enroll America.

 

Medicaid insurers struggle to pay for pricey drugs

Medicaid insurers are struggling to pay for pricey drugs, leading some to request states to increase payments so they can run their plans. Meanwhile, some states are deciding restrict the expensive medications.

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.