Patient factors dominate readmissions risks, study finds

The findings contribute to the discussion whether current Medicare policy is unfairly penalizing hospitals with significant poor and minority populations when it comes to readmission rates.

By Heather Caspi • Oct. 30, 2016

Technology, outreach efforts prime ACA open enrollment season

Mobile apps, Lyft partnerships and "hyperlocal" outreach have been included in efforts to boost insurance enrollment.

By Jeff Byers • Oct. 29, 2016

Aetna profits from government programs, just not ACA

Sales of plans through Medicare and Medicaid contracts helped fuel a strong third quarter for the insurance giant.

By Meg Bryant • Oct. 28, 2016

AHA sees erosion of physician judgment in DOJ false claims suit

DOJ accused Prime Healthcare of encouraging doctors to admit Medicare patients for short hospital stays instead of outpatient observation care.

By Meg Bryant • Oct. 28, 2016

ACA marketplace stability, or lack thereof, to come into focus in 2017

Kaiser Family Foundation's CEO Drew Altman's argues next year's insurer quarterly earnings reports will show whether their rates are aligning with their costs.

By Heather Caspi • Oct. 27, 2016

Study: Insurance cost squeeze on workers real, though premiums not to blame

While cost growth has slowed since the ACA, incomes have not kept up.

By Heather Caspi • Oct. 27, 2016

Covered California highlights recipe for individual marketplace success

The state shares how it has made the health law work for the most part.

By Heather Caspi • Oct. 26, 2016

Ignorance around 'Obamacare' impairs discussion

Trump made some remarks on the ACA on Tuesday which didn't add up.

By Heather Caspi • Oct. 26, 2016

How payers are tackling value-based drug pricing

Efforts to establish such pricing are on the rise as payers and providers challenge drug makers to help improve health outcomes. However, barriers to these payment models remain. 

By Luke Gale • Oct. 26, 2016

Advanced APMs: What they are and why they matter

Providers should look at both the downside risk potential and cost of implementing an Advanced APM.

By Meg Bryant • Oct. 26, 2016

HHS touts strides on delivery system reform goals

Public and private progress toward spending through alternative payment models is going strong.

By Heather Caspi • Oct. 26, 2016

Medicaid expansion, Health Net acquisition main drivers in Centene Q3 growth

Revenue grew year-over-year by 86%.

By Jeff Byers • Oct. 25, 2016

CMS pivots from Medicare Advantage auto-enrollment for internal review

The agency is not currently allowing any new insurers to use "seamless conversion," but disclosed 29 have already been approved.

By Heather Caspi • Oct. 25, 2016

CMS pushes for more MACRA participation with new Advanced APM options

An Oncology Care Model track will now qualify as an Advanced APM for the 2017 performance year.

By Ana Mulero • Oct. 25, 2016

AARP sues the EEOC over new wellness incentive rules

The advocacy group expressed concern that wellness program incentives may be too onerous for some employees.

By Kathryn Moody • Oct. 25, 2016

PwC: Hospitals need to think like retailers

Nearly 40% of American adults said they shop around for healthcare prices. 

By Meg Bryant • Oct. 25, 2016

3 truths about the 2017 ACA marketplace

HHS confirmed an average 25% increase for next year's benchmark ACA plan premiums.

By Jeff Byers • Oct. 24, 2016

Cigna ends prior authorization policy for addiction meds

New York state is now asking that other insurers follow suit.

By Heather Caspi • Oct. 24, 2016

Study: Expanding Medicaid doesn't reduce stress on ERs

The findings are from a two-year analysis of an Oregon experiment, which expanded Medicaid through a random lottery.

By Meg Bryant • Oct. 21, 2016

Rural hospitals out-perform urban hospitals on key quality measures

The adoption of telemedicine in rural areas has helped increase access to care. 

By Meg Bryant • Oct. 21, 2016

STD rates in US hit new high

CDC estimates about 20 million new STD infections occur each year, accounting for close to $16 billion in healthcare costs.

By Meg Bryant • Oct. 21, 2016

OIG: $358M worth of Medicare chiropractor payments officially 'unallowable'

Federal officials are at odds over implementing stronger controls to flag potentially improper billing.

By Heather Caspi • Oct. 20, 2016

Pilot for bundled maternity/birth/newborn care brings overdue coordination

An experiment in Texas can serve as a model, though expected savings have yet to be realized.

By Heather Caspi • Oct. 20, 2016

HHS projects 1.1M increase in 2017 marketplace enrollment

Insurers should expect robust enrollment growth if the government's projections pan out.

By Heather Caspi • Oct. 20, 2016

Blues taking heat in risk adjustment debate

Rivals argue the Blues plans are benefiting from their own inefficiencies.

By Heather Caspi • Oct. 19, 2016