Reimbursement
What's in a name? When it comes to health plans sold on the individual market, these days it's often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you're buying by name alone -- assuming you're one of the few people who know what an EPO is in the first place.
A newly released scorecard by the AARP Policy Institute, with support from The SCAN Foundation and The Commonwealth Fund, ranks states on how well each delivers long-term services and supports to older adults and people with disabilities.
The idea of a new "copper" tier of health plans is being pitched for the most healthy and cost-conscious consumers.
One of the most acrimonious disputes of the insurance exchange debut is coming to a close, in a testament to the market influence some providers now have.
Oregon is mandating Medicaid coverage for gender dysphoria treatment, bringing it in parity with the state's progressive commercial market and also putting pressure on other states and insurers.
When I saw Paying for the Thousand-Dollar Pill, an anti-Sovaldi op-ed in the Wall Street Journal, it brought back memories from my childhood when I toured the FBI headquarters in Washington, DC. The tour guide started off by showing us a wall with pictures of the 10 most wanted fugitives in the country and asked for our help in tracking them down.
Insurers may need to find new ways to control costs for specialty drugs, as more states add limits to cost-sharing and utilization continues to grow.
From a real estate perspective, the healthcare landscape is dramatically changing. The massive, monolithic structures that have come to represent the acute care setting are becoming more stratified in smaller buildings across wider swaths of a community.
Among providers trying to get into the insurance game, some are starting off small at the local level, but in a big, growing market segment.
The way blood-based diagnostic tests are performed and paid for could change dramatically if a new company has its way, with the potential to benefit patients and payers at the expense of traditional providers.