Reimbursement
Northwell's CareConnect in New York City rides losses, boosts premiums to stay in market.
With the financial pressure rising to demonstrate higher levels of quality, leaders need solid programs in place to keep their facilities in check.
Neither provider nor payer gave terms of new contract which had fallen apart last week over reimbursement rate dispute.
Aetna Better Health filed the termination declaration on June 29, a week before the Illinois House finally passed a $36 billion budget by overriding the veto of the governor.
One of the main culprits is the "buy-and-bill" reimbursement model for infused therapies.
Optum likely to run healthcare arm if buy-out goes through, leveraging the Advisory Board's provider relationships and Crimson dataset.
While certain programs favor large systems, plenty of providers are proving that scale doesn't always matter.
If states impose lifetime caps and eliminate essential benefits, questions of how much an insurer pays for services remains uncertain.
The contract fall-out means Blue Cross members will no longer have insurance coverage for most services provided at Children's facilities.
For the first time this week, the Centers for Medicare and Medicaid Services was scheduled to make public encounter data on Medicare Advantage plans.