Reimbursement

As a once-promising tax scheme to maximize federal Medicaid dollars fades from practicality, budget woes are coming to the fore and creating an impetus for program redesigns.

Not one year into New Hampshire's Medicaid managed care expansion, one physician-operated health plan is deciding to redirect its resources elsewhere, leaving other plans with new responsibilities.

Florida's largest insurer is humming along with its strategy of alternative reimbursement models, signing an accountable care agreement with one of Tenet's ACO networks.

Bariatric surgery has experienced a 16-fold growth in the U.S. within the last 15 years. Reimbursement for gastric band placement and gastric band removal/replacement -- the main types of bariatric procedures -- will increase by 4.5 percent and 6.8 percent respectively in 2014.

Many residents in New England are going to have more choices in the public exchanges this fall, as some insurers' growth strategies are tested.

States' taxing of Medicaid managed care organizations to raise revenue for state-share Medicaid payments may be illegal, according to the HHS Inspector General. If so, this raises serious questions that could shake up MCO financing models.

Hospitals in Georgia have struggled financially in recent years, as uncompensated care costs rose after the recession and the state rejected Medicaid expansion. But one standalone facility decided that affiliation and clinical integration might be the right path to stave off closure.

For employees, there can be nothing quite like the paperwork of HR and benefits, and for employers it can be expensive, especially with new ACA reporting requirements. Internet companies are trying to cash in on that, and could also shake up the insurance broker business.

For the first time in decades, cracks are appearing in the traditional fully insured model of healthcare coverage. The time is ripe for health systems to jump into the gap with an old approach delivered a new way -- direct contracting.

Amid new skepticism of back pain treatments, one of the largest medical device makers is being sued for a product that brought in close to one billion dollars annually at its peak while increasing risks for patients.