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How much overhead in private and government insurance will it take to have universal coverage under the ACA? Quite a bit in one current view of the data. MORE
Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them into smart shoppers. So he shopped. MORE
After more than a decade of legal turmoil, physicians in four states have won a concession from the nation's largest insurer to make getting paid less of a hassle, if not to get paid more. MORE
The federal government has crafted the first regulatory change to Medicaid managed care in a decade, as more health plans take the challenge from states to cover growing Medicaid populations at a sustainable cost. MORE
As California goes, so goes the country in capping consumer costs for medicines? That's what patient advocacy groups and and some pharmaceutical companies may be hoping. MORE
A national for-profit giant and Michigan's largest health insurer are coming to a resolution over the long-standing, fractious trade issues of excluding and favoring. MORE
A mix of old and new school insurers are the best health plans in the eyes of the 59,000 physicians and providers using the digital billing and record-keeping services of athenahealth. MORE
In 10 years, the relationships between health systems and insurers could be quite different if provider-sponsored plans can offer what health insurers currently cannot. MORE
As dry as the decision may appear, insurers literally have millions of dollars on the line when CMS comes knocking. That makes picking the right auditor, and doing so the first time, absolutely critical. MORE
The chief lobbyist for American health insurance is taking a job at a regional nonprofit insurer, after shaping a once-in-a-generation reform aimed at benefiting both the public and the industry. MORE
It was only a matter of time until a big regional Blue Cross insurer got hacked, except that time was a year ago and security experts just recently uncovered it. MORE
Aetna has found itself in the odd position of being fined for covering something some members wanted, while not being fully up to speed covering another condition. MORE
The trajectory of cancer care is so costly and problematic that insurers are flocking in droves to the federal government’s multi-payer alignment experiment. MORE
With little more than a year of claims experience on the new individual market, some insurers are looking for premium increases of more 30 percent, including the Blues. Though affordability is still relative. MORE
Molina Healthcare is acquiring a financially beleaguered Medicaid plan from a nonprofit insurer trying to preserve another managed care business. MORE
Four months until the ICD-10 deadline, and the American Medical Association is peddling the logic of waiting for the next iteration of the disease coding system, or at least delaying a bit more. MORE
Health insurers in one large West Coast state now have to disclose claims data that for decades was proprietary, in a reluctant but heralded move towards transparency. MORE
Health insurers need to change their silver-tier health plans to use more modest and predictable cost-sharing, instead of four-figure deductibles, according to patient advocates. MORE
In the first update to federal MCO rules in more than a decade, the government is set to push a range of tweaks, reforms and requirements that could set a new baseline for a bustling public payer segment. MORE
The federal government clarified that insurers can’t charge people for anesthesia administered during a preventive colonoscopy to screen for colorectal cancer, although there are unresolved questions. MORE
What’s the best way to get members to stop smoking? A financial nudge and a pinch show some promise, for a range of health and wellness choices. MORE
Aetna is plotting an acquisition seeking "inorganic growth" that could make it a rival for the largest insurer in the country, if the hype of one boutique Wall Street analyst is to be believed. MORE
On the West Coast, the nation's largest municipal-operated health plan is trying to mesh its compensation structure with its nonprofit mission. MORE
$52 billion and growing is the trend in high-cost pharmacy benefits, as more and more Americans use prescription drugs with expenses exceeding the U.S. median household income. MORE
In the late 1990s you could have taken what hospitals charged for inpatient chemotherapy and bought a Ford Escort econobox. Today average chemo charges are enough to pay for a Lexus GX SUV, not even counting the price of anti-cancer drugs. MORE
If nothing else, the collapse of multi-million dollar state-based exchanges has created a PR problem for health reform, but that’s only part of the issue. MORE
For the third year, Iowa's largest insurer is shunning the state exchange, letting for-profit competitors take on subsidized members. MORE
From the depths of the Internal Revenue Services comes an attempt to clarify some ambiguities for the uniquely taxed Blue Cross Blue Shield insurers and their medical cost ratios. MORE
When it comes to comprehensive contraception options as a preventive health benefit, free means free, regulators reminded the insurance industry. MORE
Based on insurer estimates of payables and receivables, plus an uncertain funding limit, the risk corridor program can seem like it's actually making the new individual market more shaky. MORE
While so much is changing, so much is still the same in healthcare, like the fact that some 85 percent of commercial health insurance payments are still paper-based. MORE
The increasing prevalence of diabetes is, as it happens, coming with rising costs, especially for kids. MORE
Florida Gov. Rick Scott's high-stakes visit to Washington to persuade the Obama administration to keep the federal government's $1 billion in annual funding for hospital care of the poor produced no breakthrough. MORE
From a niche option for busy parents to a $16 billion ubiquitous sub-industry, retail healthcare clinics are offering more choices for a range of ailments. And there are a lot more opportunities to evolve the model. MORE
As long as employer-sponsored benefits are here to stay, one technology company wants to be a modern kind of broker and HR service. It may or may not spell an early retirement wave for a generation of insurance producers. MORE
With new data from the Medicare Pioneer ACOs, accountable care advocates can be cautiously optimistic, although the pessimistic can also find things to latch onto as well. MORE
Cigna is seeing benefits from its variety of accountable care in obstetrics and gynecology, and is on track to expand the model. MORE
Amid record enrollment, some Medicare Advantage insurers are finding their payment-linked risk scoring practices to be the subject of scrutiny and lawsuits. MORE
Taking a cue from workplace wellness programs, more than a dozen states are offering Medicaid beneficiaries incentive to make healthier decisions. The stakes are huge. MORE
The country’s largest insurer is expanding coverage for virtual visits, a clear sign of legitimacy for a growing part of consumer-driven medicine. MORE
Unlike many local and state governments with steadily rising healthcare costs and a looming Cadillac tax, Houston is saving a fair amount with an accountable care network and wellness program. MORE
As part of a bid to improve federal healthcare programs through transparency, a new trove of Medicare Part D data has been released, offering a window into costs and prescribing trends. MORE
If the time for precision medicine is now, could the massive databases of health and drug plan claims systems be a starting point? MORE
Though it's been a booming first quarter for the major for-profit health insurers, the smaller two of the big five are not booming quite as much. MORE
Medicaid managed care specialist Centene nearly doubled its quarterly profit, wrapping its arms around more and more members while adding fuel to rumor fires about the next wave of takeovers. MORE
Aetna is again showing that the new insurance market, along with the business of health reform, can be profitable. MORE
For sale: Historic health insurance company with one million customers, $2 billion in revenue, some recent losses and mixed customer satisfaction, plus a modestly profitable voluntary benefits unit. MORE
For both insurers seeking value and health systems pursuing all things integration, there is a huge conundrum waiting for an intervention: the hospital facility fee. MORE
"We're comfortable being known as the health plan that wants to put health systems in the business of selling insurance." MORE
Lynda Douglas thought she had a deal with Tennessee. She would adopt and love a tiny, unwanted, profoundly disabled girl named Charla. The private insurance companies that run Tennessee's Medicaid program would cover Charla's healthcare. MORE

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