Reimbursement

In terms of enrollment, which two states have the least successful health insurance exchanges? The ones where the largest insurer is setting out a key segment of the new market.

Restricting access to prestigious, long-available providers can sometimes cost insurers long-held contracts and be competitive gains for others.

A program that combines a mobile app, analytics and direct intervention is showing promise in reducing the costs associated with hospitals' most expensive patients -- the so-called "super-utilizers."

For U.S. community health centers, the recent announcement of $295 million in Affordable Care Act funding was welcome news. But the five-year period of mandatory ACA funding expires next September, meaning CHCs face a reduction of up to 70 percent in grant funding.

With uncertainty in Medicare's accountable care program, some hospital systems are scrambling for long-term options and may give insurers a run for their money.

The new payment models in the healthcare marketplace all provide incentives for coordinated care as a means of improving outcomes and lowering costs, especially for chronic diseases. As a consequence, 2014 looks to be the year of the health information exchange (HIE).

From incentivizing wellness to protecting against catastrophic loss, what's old is new again in health insurance advertising.

"The ER doctor ordered the heart cath, so I just went ahead and did it. Besides, if I didn't do the cath it would make our door-to-balloon-time quality score go down."

Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year.

Some insurers are being accused of violating the spirit of health reform, by forcing people with a variety of illnesses, including Parkinson's disease, diabetes and epilepsy, to pay more for their drugs.