Reimbursement

Medicare Advantage remains an attractive option for Medicare beneficiaries, and enrollment has increased substantially, by 66 percent in the past six years. Also increasing, it seems, is coding intensity for risk adjustments.

Just as American society's views and acceptance of transgender issues are evolving, insurers are facing choices, challenges and uncertainty in adapting coverage policies for LGBT.

At the behest of affected patients and providers, Intermountain Healthcare decided to build what it calls a Personalized Care Clinic, an initiative that has the look of a patient-centered medical home, but offers services for a specific patient demographic facing complex, ongoing medical issues.

Like healthcare facilities across the country, Louisiana's hospitals must confront formidable financial challenges as care delivery models evolve and reimbursement mechanisms change.

Hospital systems buying up medical practices cite integration efforts and payment reform as a justification. Now, though, payers might rightly be concerned about where the trend can lead at local levels.

Amid a mulligan of sorts for a large state insurance exchange, an insurer with a new mission is using the old tactic of tapping brokers in a bid to vie in the big leagues.

The federal government is clamping down hard on some profit-focused patient referral and healthcare joint venture practices, although the company in question appears unfazed as it enters new forays, including some with insurers.

Will the pay-ins and payouts in the 3Rs be enough to leave insurers, and the programs, whole? Early data is offering a window into the possible dynamics. 

An established but growing player in the health insurance technology space is looking to get big and serious.

As cardiovascular disease becomes a greater risk for both older and younger Americans, there may be new grounds for steering members away from traditional diagnostics.