News

Va. Medicaid expansion draws insurer support

In Virginia, the debate regarding Medicaid expansion continues, reports the Associated Press. If the state decides to expand Medicaid to about 400,000 low-income residents, those eligible will have private insurance paid for with federal funds.

Payer CIOs: Capitalize on regulatory change

Health insurers are worried about keeping up with regulatory changes and maintaining compliance. But these challenges present significant opportunities for insurers' CIOs to improve operations with open architecture and real-time views, Healthcare Payer News reported.

Insurers keep watchful eye on costly diabetic members

Now more than ever insurers are monitoring their diabetic patients to ensure they don't miss appointments or forget to fill up prescriptions, reports the Associated Press.

Medical home must-dos for population health management

The growing population health movement has led insurers and providers to patient-centered medical homes (PCMH), accountable care organizations and other integrated care models to improve the outcomes and reduce the costs for patient populations.

Transition from medical to pharmacy benefit to save big

The cost of specialty medications is expected to rise to $235 billion by 2018, providing many cost-related challenges to payers. To off-set these costs, health insurers can move prescription benefits from medical to pharmacy coverage, according to a new Milliman report commissioned by CVS Caremark.

CMS sets sights on nondiscrimination compliance

Insurers selling exchange plans that try to boost young adult enrollment by discriminating against consumers with significant health needs or disabilities should be wary of compliance reviews, according to new qualified health plan guidance from the Centers for Medicare and Medicaid Services.

HHS Secretary Kathleen Sebelius exits as reform moves forward

Kathleen Sebelius--the public face of the botched HealthCare.gov rollout-- is stepping down from her post as secretary of the U.S. Department of Health & Human Services, according to multiple news outlets.

Self-insurance popularity sends full-risk enrollment falling

As the self-insurance market continues to rise, commercial full-risk insurance declines. Commercial full-risk enrollment fell from 80.5 million in 2011 to 78.5 million in 2012--a 2.5 percent drop, according to findings from Citi Research.

Texas docs forgo insurance for cash-based healthcare

A rising number of Texas primary care practitioners are switching to a cash-based model to avoid the bureaucracy of the health insurance system and high processing costs, The Texas Tribune reported. 

HHS Secretary Kathleen Sebelius to resign

Kathleen Sebelius is expected to announce that she is stepping down from her post as Secretary of the U.S. Department of Health & Human Services on Friday, according to multiple news outlets.

Affordable Care Act may lower liability insurance costs

The effects of expanded private coverage and Medicaid under the Affordable Care Act go beyond health insurers to other liability insurance companies, namely, auto insurers, a new report from the Rand Corporation finds.

Racial, wealth coverage gaps close among children

The percentage of children without insurance fell from 9.7 percent in 2008 to 7.5 percent in 2012, largely due to public programs like Medicaid and the Children's Health Insurance Program, according to a new report from the Robert Wood Johnson Foundation.

Employer-based coverage grew by 8.2M; Medicaid expansion bill vetoed in Maine;

News From Around the Web > Much of the 9.3 million-person increase in insurance from September 2013 to mid-March 2014 came from employer-sponsored coverage, according to a new survey from Rand...

Medicare Advantage cuts still in the cards for some insurers

Some insurers still expect to see Medicare Advantage rates drop next year, even though the Centers for Medicare & Medicaid Services reversed course on proposed rate cuts earlier this week.

Medicaid suffers from its own success

The United States has about 3 million new Medicaid enrollees, but hundreds of thousands of those consumers are still unable to obtain coverage, ProPublica reported.

Will reform bring better health to newly insured?

We now know the uninsured rate has reached a record low thanks to the Affordable Care Act, but it remains unclear whether the millions of newly insured people will actually become healthier and, therefore, reduce overall costs, reported The Health Care Blog.

Report: Single-payer insurance would be boon for businesses

If the United States implemented a single-payer health insurance system, small and large businesses would reap the benefits, including seeing their costs go down, according to a new report from Public Citizen.

Payers value patient needs in device coverage decisions

Limited data does not prevent payers from covering high-risk devices, concluded a new study commissioned by The Pew Charitable Trusts.

Specialty drug use high among exchange enrollees

New enrollees who purchased coverage through state and federal marketplaces are more likely to use specialty medications, such as those used to treat HIV/AIDs and hepatitis C, than people enrolled in commercial health plans, Express Scripts research finds.

WellPoint leads opposition to Calif. rate regulation

WellPoint and other California insurers have donated $13.4 million toward defeating a ballot initiative that would authorize California regulators to reject increases in premiums, Bloomberg reported.