Reimbursement

Humana is working with a health IT company to roll out an electronic prior authorization model that enables physicians to simplify prescription prior authorization requests so patients can get quicker access to their medications.

"Repeal and replace" has been the mantra of Affordable Care Act/ObamaCare opponents almost since ObamaCare.  Although the "repeal" part has been tried many times in the House, very little serious attention has been paid to the "replace" part.

The Aetna Foundation, the charitable arm of the Hartford-based insurance giant, is looking to make the cellphone the centerpiece of efforts to improve public health access with a three-year, $4 million Digital Health Initiative.

When CVS Caremark announced that it would no longer sell cigarettes, it was the latest sign of the direction retail pharmacies have been moving in over the last few years.

People in much of Minnesota, northwestern Pennsylvania and Tucson, Ariz., are getting the best bargains from the health care law's new insurance marketplaces: premiums half the price or less than what insurers in the country's most expensive places are charging.

Once an organization decides to transition to the accountable care model, there is an immediate need to begin long-term financial planning. While your organization is working to drive down costs, it must also look for ways to maintain profitability.

As the industry continues to digest the Affordable Care Act and the implications of market reform, health plans need to understand how to weave in more consumer-focused entrepreneurialism, innovation and diversification into the core business.

The Obama Administration's latest delays and policy tweaks have credit rating analysts getting more worried about insurers, even as large companies like Aetna and Cigna insist that insurance exchanges are only minor parts of their business strategies.

Most uninsured Latinos are eligible for tax credits or Medicaid, but insurers may need to rethink their outreach approaches, and absent federal immigration reform, states may have to help fill gaps for those who are both uninsured and undocumented.

Between 20 years researching leukemia at Harvard and four years directing Merck's oncology program, Gary Gilliland, MD, has seen a lot of ups and even more downs. Now, as the head of precision medicine at Penn, he's fairly optimistic about emerging therapies like immunologics, but just as concerned about how to pay for them.