Reimbursement

While Medicare's ACOs have had mixed early outcomes, some young commercial accountable care ventures, including PPO plans, are showing promise.

The boom in employer self-funding is coming along with many more catastrophic claims, raising concerns for insurers bundling third-party administrative services and stop-loss coverage.

Healthcare reform and the shift toward value instead of volume underscore the importance of population health management for improving patient outcomes on a large scale. One essential component of a comprehensive population health program is patient access.

States are making a bold move toward healthcare transparency, betting that easily-available hospital data will empower consumers and drive quality changes.

The Centers for Medicare & Medicaid Services (CMS) recently released its model documents for the 2015 Annual Enrollment Period (AEP). The rigorous, highly complex rules and regulations for member marketing materials wreak havoc on health plans year after year. The clock is now ticking.

As new generations age, with some 10,000 Americans expected to turn 65 every day over the next 15 years, the ability to extend life is increasing. But a logistical conversation about death is one that families, couples and policymakers can't avoid.

Much-loved by a key consumer demographic and highly-guarded by its corporate parent, Trader Joe's has pioneered affordable, great quality groceries. Can its model work in America's healthcare system?

As Medicaid enrollment grows to record levels, covering 65 million people nationwide, providers are starting to see some positive trends in their rates of uncompensated care, as managed care organizations garner new membership.

Hospitals in states that have expanded Medicaid eligibility under the Affordable Care Act are already bringing in fewer self-pay and charity care patient cases, according to an analysis by the Colorado Hospital Association.

As providers continue adjusting to the reimbursement changes wrought by the Affordable Care Act, it appears increasingly likely that hospitals will place more emphasis on collecting payments at the point of service.