Reimbursement

The American College of Emergency Physicians is suing the Department of Health and Human Services and other federal agencies for setting payment rules that result in inadequate reimbursement for out-of-network emergency medical services, according to the civil lawsuit filed in U.S. District Court on May 12.

A shared health information platform makes for effective teamwork.

Cigna said it would tap into its experience with prevention, wellness and chronic disease management programs to will work with clients, physicians and others to develop ways to increase prevention and treatment of substance use disorders.

Sponsored by Xerox. While there is optimism around the shift, payers and providers have a long list of concerns. Where is the industry finding the most challenge now?

As margins are squeezed, interest in provider-sponsored health plans continues to increase. The expectation, according to a new PwC report, is that half of health systems will be applying or will consider applying for an insurance license.

Kim Keck, senior vice president of Aetna, will become the president and chief executive officer of Blue Cross & Blue Shield of Rhode Island in June, the nonprofit insurer announced Thursday.

Humana is partnering with four orthopedic specialty groups in Tennessee, and an additional two in Ohio, on bundled payments for Humana Medicare Advantage members undergoing total hip or knee joint replacement.

Cigna has teamed up with Integrated Independent Physicians Network in Florida for an accountable care organization model that rewards doctors for having a healthier population and saving money.

Payers have until June 6 to submit documents for Medicare's Annual Election Period materials including the Annual Notification of Change, Evidence of Coverage and Summary of Benefits documents.

The stakes are high for the companies and CalPERS, which is struggling along with many employers nationwide to contain fast-rising drug costs.