News

Public sector retirees to pay costly premiums for plans

The private sector began to eliminate retiree health insurance benefits back in the 1990s--will the public sector follow?

Ebola pandemic would be costly to health insurers

If an Ebola pandemic hits American soil, the need for increased testing to detect the virus and the high cost to treat people who are infected could hit insurers hard.

Cigna launches gamified digital health coaching

Cigna has launched a new digital health coaching program that offers a "digital ecosystem" of mobile tools, social media engagement, gamification and web-based incentives to help its members meet their health goals.

Medicaid expansion faces roll-back in Ohio

Ohio's Medicaid expansion may not last, University Hospitals Chief Executive Tom Zenty told a Cleveland audience recently, reports Kaiser Health News

Feds prepare for ACA open enrollment with an improved Healthcare.gov

As open enrollment nears for plans offered pursuant to the Affordable Care Act, HealthCare.gov is making headlines again with coverage about how the new version of the federal enrollment website is better than the old. Despite the revamp, though, "things are still complicated," according to the Associated Press.

CMS' Medicare Advantage Star Ratings on the rise

Overall performance for Medicare Advantage plans with and without prescription drug coverage is on the rise--and the Centers for Medicare & Medicaid Services credits its Star Ratings program for driving quality improvement. 

HHS working with states on exchanges, Medicaid enrollment issues

To help ensure a smoother enrollment process this year, the U.S. Department of Health & Human Services is working with state health insurance exchanges, especially ones that struggled amid technical difficulties last year, as well as Medicaid officials.

Aetna drives value-based reform by collaborating with one provider in market

Aetna has experienced a lot of success with its accountable care organizations, in which it establishes a trusting relationship with its provider partners to steer value-based reform throughout the country. One of the keys to that success has been choosing one major integrated health system in each market to partner with--and then excluding all the other providers in the area.

Covered California dishes out no-bid contracts

Covered California awarded $184 million in contracts without following the typical standard competitive bidding process, reports the Associated Press

Feds release guidance on reference pricing, network adequacy in ACA group plans

The U.S. Departments of Labor, Treasury and Health and Human Services released a frequently-asked question document offering guidance on the use of reference pricing in non-grandfathered large group employer plans. This may be the first time the departments have tried to regulate group health plan network requirements under the Affordable Care Act according to a Health Affairs blog post by attorney Timothy Jost.

Insurers scrutinized for Medicare plans

Medicare health plans are in the spotlight once again, but not in a good way. Federal officials aren't pleased with the plans, citing dozens of federal audit reports that indicate the same kind of deficiencies year after year, reports the The New York Times.

Taking a stand against provider consolidation

I'm rarely one to advocate for fighting instead of finding peace, but every now and then, you just have to stand up for what you think is right. And that's how I view the recent decision from Blue Cross Blue Shield of Illinois to not negotiate with hospitals that affiliate with each other. I recognize the right of providers to work together and address the problem of ever-rising healthcare costs. And I certainly don't think that provider consolidation is the only driver to those increasing costs. Insurers have their share of blame, as well.

State: Highmark should include UPMC in its Medicare Advantage network

The Pennsylvania Attorney General and the departments of health and insurance want Highmark to expand its Medicare Advantage plans to include the University of Pittsburgh Medical Center within its network.

ACOs can help deliver population health, Cigna exec says

Collaborative care models like accountable care organizations are the "tip of the iceberg" helping insurers deliver population health to consumers, says Harriet Wallsh, a clinical program director with Cigna Collaborative Care.

Parkview Health and UnitedHealth cut ties

Indiana-based Parkview Health recently announced its plan to drop UnitedHealthcare from its provider group, according to a statement released to NewsChannel 15.

Financial challenges plague Federally Qualified Health Centers

Federally Qualified Health Centers provide care to those who need it the most in a not-so-lavish way. They also do something that other high-funded medical groups do not, writes Todd Rothenhaus, M.D., chief medical officer for AthenaHealth, in a blog post: They focus on the patients and providers' quality of care, and worry little about revenue.

Volume vs. value: The ongoing struggle

Healthcare organizations are caught between the gap of the volume model and the value model while trying to transition to the latter, American Hospital Association board Chairman and Presbyterian Healthcare Services CEO Jim Hinton recently told the New Mexico Hospital Association. 

Insurers lose $73M in Kansas in 6 months thanks to Medicaid

Medicaid expansion under the Affordable Care Act has been an overall success for insurers in most states that have implemented it; however, the story is different in Kansas, which switched its entire Medicaid program to a private model.

Reference pricing exposes cost variation, but doesn't save money

Although the practice of reference pricing helps emphasize the wide variation in medical costs, it doesn't actually decrease healthcare spending, according to a new report.

Highmark, UPMC continue to butt heads

Pennsylvania Attorney General Kathleen Kane told Highmark that the state would seek enforcement in court because the insurer is not complying with the deal it struck with UPMC this past summer.