Reimbursement
Federal health officials and state exchange leaders may be pleased with enrollment and plan choices in many places, but long-term financing is a puzzle yet to be solved.
Although it may be tempting to rely on the status quo when it comes to payer payment, opportunities exist to boost collections by shifting key activities upfront and leveraging revenue-driving tools and processes on both the front and back ends of the revenue cycle.
Provider network controversies from the first Affordable Care Act enrollment are coming back to bite two large Blues in the second open enrollment, while raising questions about responsibility for consumer confusion.
Accountable care organizations can be risky business. ACO care partners must be able to depend on one another for proper patient handling, data flow, clinical cooperation, revenue sharing and other agreed-upon measures.
The change from a fee-for-service healthcare model to a value-based approach might be inevitable, but that doesn't mean it's happening quickly. In fact, the majority of providers remain tied to the old model.
California's experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.
The proliferation and variety of accountable care designs in commercial insurance, Medicare Advantage and managed Medicaid highlight the need predict the appropriate cost of care, ensure access to needed services and raise quality. But how can value be measured?
Want to pay your health plan premiums while picking up medications, buying some batteries (or maybe a piece of chocolate) and getting a free cholesterol screening? Humana is betting that retail convenience will support its individual membership business.
A new payer-led patient information exchange in California is getting ready to hit the ground running.
Not only are employers prone to switching their health plans, but more are ending their group health benefits altogether, a sign of the growing importance of the individual market.