Reimbursement

Even as total Medicare Part D spending grows, generic competition and copay variation have yielded a sustainable rate of per capita cost growth, according to federal Medicare researchers.

As new federal market stabilization programs start, many regulators and insurers are preparing for a new model of risk management: "when adverse selection isn't."

A critical best practice for building an exchange that can operate as expected on day one was learning to say "no," according to the experience of the executives leading the Connecticut and District of Columbia health insurance marketplaces. 

Pennsylvania is asking the federal government to experiment with a range of healthcare delivery and payment reforms, and Medicaid is being eyed as a good fit for the patient-centered medical home.

In late December, President Obama signed into law the Bipartisan Budget Act of 2013, which includes the Pathway for SGR Reform Act of 2013. While SGR drew most of the media attention, the Act includes a number of other provisions impacting the Medicare and Medicaid programs.

The California Department of Managed Health Care is trying to end the practice of emergency care "balance billing," just as thousands of new HMO members are being created.

Call 2013 the time that ICD-10 stood still. Certain facets of the industry may actually be less prepared than last January, while some organizations made industry-leading strides.

It's been rare that state credit ratings have been driven by Medicaid budgets, but that could be changing. 

Despite the noise around the higher cost of some health plans on the exchanges, rate increases generally have more to do with the trend of steadily higher medical costs than with provisions of the Affordable Care Act.

Global pharmaceuticals and healthcare products company Abbott Laboratories has agreed to pay the United States $5.475 million to resolve allegations that the company violated the False Claims Act by paying improper kickbacks to induce doctors to use some of its products.