Reimbursement
The Obama Administration wants to make it as easy as possible for the 8 million Americans who bought insurance via an exchange last year to keep their plans. To that end, the auto-enrollment policy Health and Human Services unwrapped aims to reduce complexity for insurers, but it also brings new issues.
Two large players in a small market are going to spend the next three years trying to collaborate with emerging incentives, as shared risk becomes the new normal.
The individual insurance market is now too big to ignore, drawing new crowds on and off state exchanges.
In this Golden Age of government programs, the health plan industry has never had more exposure to the generally poor performance of pharmacy benefit managers (PBMs). Performance metrics in Medicare, Medicaid and ObamaCare are directly tied to PBM execution, and the recent track record of these companies means they are the Achille's Heel of insurers.
Ambulatory surgery centers have new evidence to back up arguments for its relative cost-effectiveness.
As health plans start serving newly-insured populations and try to improve outcomes for long-time patients, all while taking on more financial risk, the case for aggressively targeting diabetes and obesity has never been greater.
The ambulatory surgery center movement has some evidence to back up arguments for its relative cost-effectiveness, although variation can still be vexing for health plans and patients.
The nation's diabetes and obesity crises have started taking their toll on healthcare spending, and some insurers are stepping in before new generations develop these problems in the long-term.
Just as government marketplaces are transforming their individual policy businesses, Blue Cross and Blue Shield companies are setting up private exchanges to save a far larger source of traditional revenue.
A quarter of the nation's hospitals in October will receive lower Medicare payments because their rates of patient complications are higher than their peers. Here is an explanation of the three measures Medicare is using to calculate the hospital-acquired conditions scores.