Best practices for payer health management programs

Health IT tools and more transparent relationships with providers are among the best practices that can help health insurance companies improve health management programs, according to a new report by IDC Health Insights.

Stanford professor predicts doom for health insurers

Competition among health systems and pressure to cut costs will transform--if not doom--health insurance companies in their current form, Stanford University Professor Jeffrey Pfeffer argues in a Fortune article. 

SHOP exchanges face sluggish adoption, technical glitches

The Small Business Health Options Program (SHOP) exchanges were meant to drive down costs and boost enrollment. But the program, part of the Affordable Care Act, has yet to reap anticipated rewards.

Let's address the dark side of Medicare Advantage plans

Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well.

In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have.

This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.

Horizon expands patient-centered care programs

Horizon Blue Cross Blue Shield of New Jersey is expanding its patient-centered practices to its newest Medicare Advantage plan. 

With wellness programs, companies search for the keys to worker motivation

Noting the trend toward tying employees' health insurance premiums to their willingness to participate in a wellness program, a Columbus CEO article points to keys to creating successful programs.

Delaware drops Medcaid coverage, job losses likely

Delaware's department of Health and Social Services will stop offering Medicaid coverage through Delaware Physicians Care, an Aetna health plan, reports The News Journal.

Good news: Healthcare spending slowing down, may help GDP

Over the years, healthcare spending has taken up a large portion of the U.S. economy's gross domestic product. Additionally, the U.S.'s proportion of GDP spent on healthcare continues to rise faster than any other developed nation. Yet there is a silver lining: Healthcare spending is slowing down.

Obama administration likely to block plans excluding hospital benefits, sources say

The Obama administration will likely kill an option under the Affordable Care Act that lets large employers offer health plans that exclude hospital benefits, sources told Kaiser Health News.

Bundled payments can be gateway to payment reform

When insurers implement bundled payment projects, they're transforming care by focusing on quality and lowering costs, making it a strong gateway to propel payment reform, according to a report from the Robert Wood Johnson Institute.

Asian Americans face language barriers when purchasing health insurance

Most details regarding how to purchase health insurance are either in English or Spanish. This poses a problem for Asian American consumers who may experience a language barrier when it comes time to enrolling, reports Kaiser Health News.

Can state-run exchanges work without the ACA?

What would happen if state-run exchanges disconnected completely from the Affordable Care Act and acted as independent agents? Is such a thing even possible?

Government won't send notice when members switch insurance companies

Despite promises of a smoother enrollment process through the federal health insurance marketplace, some health insurance execs say the way the government plans to notify insurers about enrollment changes could cause confusion and lead to double-billing. 

HHS official calls for tougher audits of Medicare Advantage plans

The Centers for Medicare & Medicaid Services should implement tighter audit standards to prevent Medicare Advantage plans from using unfair billing practices that lead to excessive reimbursements, a senior official with the U.S. Department of Health & Human Services told the Center for Public Integrity.

Massachusetts is driving consumer-oriented focus in industry

As Massachusetts became the first state earlier this month to require insurers provide real-time prices for all covered medical services, it's leading the trend toward a more consumer-oriented healthcare insurance industry.

Studies reveal rise and fall of ER use

The idea that Medicaid expansion will wreak havoc with state budgets due to increased hospital use by the previously-uninsured was challenged by results of a recent study by the UCLA Center for Health Policy Research. While rates of hospital and emergency room use rose soon after people enrolled in low-cost, government health plans, utilization of these services dropped off within a year, researchers found.

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