Reimbursement

One of the nation's largest health insurance advocacy groups is welcoming in a new chief executive, amid a tumultuous regulatory environment.

Amid record enrollment in Medicaid and state concerns about the program's budgetary sustainability, the federal government is offering new financial support and policy options.

In California, insurers and regulators are fighting for control of the post-reform insurance market.

Cancer treatment costs are among the highest in the healthcare industry. Insurer UnitedHealthcare created a pilot in an attempt to lower costs that has yielded some promising, though somewhat mixed results.

Blue Cross and Blue Shield companies are making progress in its transition from fee-for-service to value-based reimbursement models.

With federal rules governing health plan spending looking like they're here to stay, insurers are making inroads on compliance, although they will hope for possible tweaks in the future.

With the first healthcare exchange open enrollment period concluded, savvy health plan marketers are spending much of their time and resources sifting through enrollment data hoping to gaint insights. However, this is a new world for plan providers, and most current marketing plans and sales strategies were developed for commercial and Medicare sales.

The Affordable Care Act included a number of delivery system reforms, such as ACOs, bundled payments, and workforce provisions to strengthen foundations in primary care. Unfortunately, a focused effort on payments for specialists was not included.

As Affordable Care Act exchanges bring health plans to previously uninsured Americans, there are also market segment transitions that could prove favorable for risk pools.

Trying to help transition the American healthcare system beyond fee-for-service, Blue Cross and Blue Shield companies are starting to reach new reimbursement milestones.