Reimbursement

Only five states states are making headway bringing more price transparency to healthcare markets, but they could be a model for others, especially those with all-payer claims databases.

The federal government is promising that anyone who wants to buy subsidized insurance will be able to as long as they try to enroll before March 31. But insurers should expect more surprises and lingering work from complex cases.

The executive who ran IT for Coca Cola is coming to WellPoint to oversee and optimize technology across health plans and other, evolving businesses, including one advanced project with high expectations.

With a new study showing both inpatient reductions and specialty care increases linked to high-risk medical home patients, health systems have more evidence to buy into the PCMH model as part of their clinical and financial improvement strategies.

With a new study of Independence Blue Cross members, evidence on the effectiveness of the patient-centered medical home is swinging back towards the positive.

Aetna has won a huge state contract in Texas, pulling away 415,000 lives from Blue Cross Blue Shield and with them several billion dollars in revenue.

What's driving the highest per capita healthcare spending in the country? A half-decade's worth of government-funded research points to some contentious and perhaps uncomfortable trends.

Physicians groups want to preserve a key antitrust exemption for self-referrals under Medicare that the Obama Administration hopes to end for a number of costly services.

Health insurers can expect an increasing number of consumer education challenges around prescription drug management, as utilization controls are more prevalent in public exchange plans than in typical group insurance.

With open enrollment coming to a close, public insurance exchanges are starting to look like they won't be the money-loser many have been girding for, at least for WellPoint's health plans.