Reimbursement

Never before has the need been stronger to ensure product and plan configuration is leveraged across the enterprise, from upstream activities like product strategy and sales to downstream processes like claims management.

On the West Coast, the nation's largest municipal-operated health plan is trying to mesh its compensation structure with its nonprofit mission.

$52 billion and growing is the trend in high-cost pharmacy benefits, as more and more Americans use prescription drugs with expenses exceeding the U.S. median household income.

With out-of-pocket costs for patients increasing due to the popularity of high deductible health plans, and with so few purchasers taking advantage of health savings accounts, the risk of bad debt and charity care has increased for healthcare providers.

In the late 1990s you could have taken what hospitals charged for inpatient chemotherapy and bought a Ford Escort econobox. Today average chemo charges are enough to pay for a Lexus GX SUV, not even counting the price of anti-cancer drugs.

If nothing else, the collapse of multi-million dollar state-based exchanges has created a PR problem for health reform, but that's only part of the issue.

For the third year, Iowa's largest insurer is shunning the state exchange, letting for-profit competitors take on subsidized members.

Study by Standard & Poor's finds a number of provider-owned health plans and cooperative insurers may not get the funding they had hoped for.

From the depths of the Internal Revenue Services comes an attempt to clarify some ambiguities for the uniquely taxed Blue Cross Blue Shield insurers and their medical cost ratios.

When it comes to comprehensive contraception options as a preventive health benefit, free means free, regulators reminded the insurance industry.