AHIP asks feds to consider risk adjustment program changes

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. 

How CMS proposes to align Medicaid managed care with private plans

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.


4 ways health insurers can engage customers through exchanges

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.


Senators push CMS to rethink Medicare Part B payment proposal

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.

Anthem ACOs save providers $14.8M in one year

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's first-quarter net income falls 7%

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


Polls point to deep divide in views of Affordable Care Act

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.

States take action to ban payers from gender identity discrimination

Insurance companies in Hawaii and Pennsylvania may no longer discriminate against transgendered people when approving coverage for certain medical procedures.

MACRA proposed rule: What it means for Medicare Advantage

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.


BCBSNC reimbursement delays hurt physician practices

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.


Insurers predict hefty premium hikes in 2017

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 drops 19% in Q1

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.

Overlapping coverage can help mitigate churn

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 managed care rule: Health plans, state directors cautiously optimistic

Medicaid directors and health plans have mixed feelings about the newly finalized federal regulations for Medicaid managed care plans.


Where UnitedHealth leads, other payers appear to follow

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.


Strategic pricing key to some insurers' success in ACA marketplace

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.  


BCBS of Michigan embraces electronic prior authorization

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's immigrant-coverage idea likely to face blowback

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.

Report: Reinsurance windfall not enough to keep ACA plans from steep losses

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 reaps ROI through education reimbursement program

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.