Reimbursement

Aetna, Cigna and the Blues sprang out of the gate in just the first two weeks of the year with announcements of newly formed accountable care organizations and expansions of existing ones, adding more scale and breadth to testing of value-based models to deliver better care at lower cost.

Enrollment in Medicaid managed care is continuing its growth in tandem with eligibility expansion, bringing benefits and challenges to insurers, according to an Avalere Health analysis.

After requiring small businesses to buy insurance through the state exchange, continued website dysfunction has left Vermont health officials asking businesses to enroll directly with insurers.

Reimbursing a physician for their time spent in having end-of-life discussions is not an incentive for a "death panel" decision; it would be compensating them for doing their job. If all we do is compensate physicians for treating people aggressively regardless of the circumstances, we will get what we pay for: an expensive healthcare system run amok.

The growth of generic drugs has been a good news story for payers and pharmaceutical benefit managers (PBMs), but that story may be coming to an end.

With the growing complexity and unpredictability of reimbursement, the existing back-end model of managing patients' payments is no longer sufficient. Hospital executives must focus on a proactive approach to collecting payment upfront as well as improving patient education.

In a reversal of 30 years' past practice, Medicare may start to disclose what it pays individual physicians for its services to seniors.

In a reversal of 30 years' past practice, Medicare may start to disclose what it pays individual physicians for its services to seniors.

Hospitals have been acquiring physician practices and have been doing so for years, but a case resting in the hands of a federal judge in Boise is proving to be a "banner" case for these sorts of mergers and acquisitions.

Of the 2.2 million people who have signed up for coverage on federal and state health insurance exchanges, just 24 percent are young adults, the age group most prized for the healthy balance that they can bring to the nation's risk pool to hold down premium costs.