Reimbursement

Medicare plans are mid-way through the process of creating Annual Election Period (AEP) materials that are due to members by the end of September. At this stage of the game, tension is running high and time is running out.

Many insurers setting premiums for the upcoming exchange season seem to be banking on consumer price sensitivity. Some are also poised to draw the most cost-conscious enrollees away from competitors.

Accountable care organizations are captivating because they contain elements of care delivery that most experts agree should improve healthcare: financial risk sharing, electronic health records, quality benchmarks, patient engagement and care coordination. But the question remains: can ACOs pull it off?

With more than 10 million Americans newly insured so far under the Affordable Care Act, enormous changes to insurance coverage in the individual and Medicaid markets are occurring. At the same time, major changes to rating practices in the small group market are also taking place, prompting concerns about the effect of the ACA on premiums for the large and small group markets.

Highmark, an insurer with its own health system, is challenging a growing and controversial billing practice that also happens to be a central part of some health system integration strategies.

While others have dispassionately made the point that there are unexplained variations in Medicare physician billing data that warrant careful consideration when using such data, one doctor thinks CMS has devious motives.

The pharmacy benefits industry is challenging a new state law, trying to protect a key management tool that insurers, employer groups and public payers have been relying on for cost stability.

Signing people up for health insurance is the easy part of Rawha Abouarabi's job ministering to immigrants and Arab Americans in this manufacturing hub along the Rouge River in Dearborn, Michigan.

For a state trying to get a handle on notoriously high healthcare spending, there are some reasons to be cautiously optimistic and keep following those with the most market power.

A new analysis of hospital readmissions allows state Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population, and provides a baseline for measuring improvement.