Reimbursement

Of all the health organizations working as Medicaid managed care plans, a good number of provider-based plans are thriving, sometimes in places where traditional Medicaid HMOs are not.

Are we designing our population health management programs to serve the consumer in the year 2000 or today and beyond?

Along with the changes and new costs coming with health reform, past problems are cropping up for some insurers, even setting regulatory records.

The employer wellness movement is gaining steam globally, but some trends are hitting a wall.

One state is finding new approaches to managing Medicaid frequent fliers.

Imagine trying to run a successful business when employers, competitors, and other service providers have launched focused campaigns that encourage consumers to avoid you. If you run a restaurant or an auto-repair shop, this scenario is far-fetched. If you run a hospital, it's reality.

Just in case you didn't get the memo earlier this week, hospitals should take note that the Centers for Medicare & Medicaid Services will soon allow Recovery Auditors to restart some reviews.

Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come.

Pretty soon, 24/7 digital access to a physician or nurse practitioner could be a standard health plan benefit.

Chief financial officers at hospitals and health systems must track a multitude of difficult financial issues these days. One question, however, always stops a conversation cold: Why are our reimbursements declining?