Reimbursement

Managing ambulatory care used to be about taking care of patients while managing your budget. Those days will have to change to stay competitive with the new payment model.

The days of cryptic invoicing are coming to an end for healthcare, or at it least they should be, financial experts say.

The Medicaid and CHIP Payment and Access Commission is out with its biannual report, proposing a number of changes to eligibility, premiums and disclosure policies, including some intertwining with exchange health plans.

There are news reports indicating Republicans will be proposing such longstanding health insurance reform ideas as selling insurance across state lines and association health plans.

Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on.

As Montana's Blue Cross company evolves under a new corporate parent, state regulators are penalizing it for some alleged past misdeeds uncovered by an audit.

Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country.

With a banner of its logo draped over the New York Stock Exchange on the Friday before St. Patrick's Day, Castlight Health went public, in another sign that reducing friction and opacity in healthcare is sparking a gold rush of sorts.

Depending on the outcome of a lawsuit Cigna is pursuing in Los Angeles, more out-of-network providers may be able to offer patients discounts while billing health plans in full.

Studies and predictions around customer engagement and behavior trends focus on the empowered, online consumer. Forbes and Marketo cite that consumers expect super-personalized communications, consistent multi-channel interactions and sleek efficient tools. Payers are hit with delivering against these heightened expectations while responding to a host of new regulatory requirements. Luckily this double whammy has a silver lining; the technologies and tools that consumers demand can improve subscriber loyalty and the bottom line.