Reimbursement

Buried in the fine print of many marketplace health plan documents is language that allows them to refuse to cover a range of services, many of which disproportionately affect women, a recent study found.

While telehealth is gaining ground as a way for healthcare providers to save money, concerns over the quality of care received still need to be ironed out, according to a new briefing from Health Affairs.

Citing over $600 million in losses and the lack of a federal safety net for the Affordable Care Act's high-risk pool, Aetna is exiting the exchange market in all but four states, Chairman and CEO Mark Bertolini said Monday.

Eighty-five percent of hospitals required to participate in the new Medicare cardiac bundled payment models will not experience gains or losses that exceed $500,000 per year, based on their current spending patterns, according to a new study by Avalere.

A new Government Accountability Office report to the chairman of the Senate Finance Committee claims that federal rules may hinder states from applying to waive sections of the Affordable Care Act to make marketplace health insurance provisions more innovative.

Instead of buying a health insurance policy to cover their workers, a growing number of small and midsized companies are opting to pay their employees' medical claims directly, a potentially riskier practice financially called self-insuring, a recent study found.

Despite dire warnings from Republicans and some large insurers about the stability of the Affordable Care Act exchanges, an Obama administration report released Thursday indicated the individual health insurance market has steadily added healthier and lower-risk consumers.

In future rulemaking, the Centers for Medicare and Medicaid Services will propose that all issuers fund a small payment to the risk adjustment program to help marketplace insurers with high claims costs.

Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness.

Aetna has aligned with Duke Health and WakeMed Health & Hospitals in North Carolina on an expanded accountable care collaboration that will be open to larger, self-funded employers.