America's Health Insurance Plans is urging the Centers for Medicare & Medicaid Services to consider making "targeted changes" to improve the risk adjustment model it uses to stabilize the Affordable Care Act marketplaces.
Among the many provisions in the newly finalized rule for Medicaid managed care, the federal government seeks to align MMC regulations with ones that govern other privately managed plans.
Amid the healthcare industry's shift to a consumer-focused business model, one health insurer has embraced the change by creating its own exchange platform to sell coverage in what it sees as a more effective and engaging manner.
Both Democrats and Republicans in the Senate have added their voices to the rising chorus of concern about the Obama administration's proposal to test new payment models for Medicare Part B.
Care coordination efforts initiated through Anthem's accountable care organization saved four medical groups nearly $15 million over the course of one year, according to a post on the State of Reform website.
Aetna saw its Q1 net income decrease 7 percent--from $777.5 million to $726.6M--from 2015 to 2016, the insurer said in its earnings report Wednesday, and its total medical membership has fallen since the beginning of the year. However, its operating revenue rose 4 percent in the first quarter compared to the same period in 2015
While the public at large appears to have negative views of the Affordable Care Act, an increasing number of Democrats want to expand the ACA, reflecting a widening divide between the law's supporters and opponents, according to two new opinion polls.
Insurance companies in Hawaii and Pennsylvania may no longer discriminate against transgendered people when approving coverage for certain medical procedures.
Medicare's newly proposed physician payment overhaul includes clues that federal health officials want to credit participation in Medicare Advantage plans toward alternative payment models.
Blue Cross Blue Shield of North Carolina's inability to reimburse some providers due to continuing technical glitches is causing financial strain and headaches for some physician practices, according to an article from the News & Observer.
Citing financial pitfalls over the last two years due to sicker, costlier patients in the Affordable Care Act marketplace, insurers are predicting double-digit premium increases for 2017, according to the Associated Press.
Anthem's net income dropped 19 percent year-over-year, from $865 million to $703 million, the insurer said in an earnings report out Wednesday. However, the insurer reiterated its 2016 adjusted earnings outlook of greater than $10.80 a share, and it saw an uptick in its total medical membership, which rose 2.8 percent in Q1 2016 compared to the year prior.
Five states have already reported a 14 percent decline in Affordable Care Act marketplace enrollment, an early projection that raises concerns that the rest of the country will see increased churn throughout the year, according to Investor's Business Daily.
Medicaid directors and health plans have mixed feelings about the newly finalized federal regulations for Medicaid managed care plans.
Though UnitedHealth has struggled with its Affordable Care Act exchange business, the country's largest payer has also played a powerful rule in influencing other insurers to change the way they do business, according to an article from Investopedia.
Despite finanical losses among some of the "big five" heatlh insurers, several smaller health plans are experiencing significant growth within their exchange plans thanks to premium price planning and comprehensive provider partnerships.
A project at Blue Cross Blue Shield of Michigan offers valuable lessons for the healthcare industry's transition to electronic prior authorization according to a Managed Healthcare Executive article.
California lawmakers' plan to ask federal health officials to allow undocumented immigrants to purchase health plans on the state exchange could not only set a national precedent, but also create a "combustible" political reaction, Kaiser Health News reports.
Though insurers received larger-than-predicted payouts from the reinsurance program in 2014, they still lost more than $2.2 billion on Affordable Care Act exchange plans that year, according to a new study from George Mason University's Mercatus Center.
Cigna's investment in employee education has paid off for the insurer in the form of tangible cost savings, according to a new study from the Lumina Foundation.