Reimbursement

According to a study published this week in Health Affairs, the Great Recession did not have a permanent negative financial impact on vulnerable hospitals, such as safety net facilities, or those considered financially weak prior to the recession. However, this doesn't mean these same hospitals will fare so well in coming years.

A media specialist who shares roots with Affordable Care Act foes is taking the communications helm of AHIP, tasked with defending an industry in transition and often under scrutiny for narrow networks and premium affordability.

In a changing healthcare economy, commercial payers have to re-evaluate how they do business with hospitals in order to contain costs while also meeting the demands of their members, many of whom are seeking expensive surgeries such as knee and hip replacements.

As an alternative to traditional eligibility expansion, one Republican hopes to bring consumer-directed insurance to Medicaid while also bridging a gap in the lower end of the group insurance market.

Although accountable care organizations are still in their nascent stages, a few large provider groups and payers may be ahead of the curve on operations and performance.

Next year, when Americans go looking for the best surgeon or cheapest MRI, many will have free access to a new comparison service started by three insurance giants.

Several million young people purchasing subsidized exchange plans was greated as a positive development for all involved. But being young does not mean being free from chronic or acute illness, as early data on one insurer's new enrollees shows.

With a new fiscal year approaching in many states, a big financial cloud is hanging over Medicaid managed care organizations: the Affordable Care Act's insurance fee.

Twenty-four states, including almost the whole South, took the stubborn path and have so far refused to expand Medicaid. That's a big reason rural hospitals are continuing to struggle.

An extension of presumptive eligibility coverage takes away Medicaid payment uncertainty if hospitals make the effort to participate and follow the rules.