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With new incentives, hospitals are increasingly making the reduction of complications, infections and readmissions a priority, but there are still infrastructure gaps that can tangle payer-provider collaboration. MORE
While some state exchange executives exited their exchanges amid foundering technology and low public esteem, the director of one successful state HIX has landed in the growing private exchange unit of a large national insurer. MORE
Ahead of the next open enrollment period, federal regulators are trying to clarify rules for member non-payment and grace periods, but insurers and providers may still have lingering concerns about getting paid. MORE
Americans across the country may be pleasantly surprised to get a small check from their health plans this summer, but insurers may need to plan better if they want avoid an administrative hassle. MORE
At a time when states are both reforming Medicaid and expanding managed care, insurers have a lot of opportunities but also face many financial pressures. MORE
The nation's largest health insurer is making its free mobile app available to everyone, in a bid to move the needle on price transparency. MORE
If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts. MORE
In the latest battle of the health reform wars, four words could bring down the Affordable Care Act's main insurance expansion policy, depending on which court interpretations gain traction. MORE
A direct primary care company is targeting employers with a new self-funding model that could spell disruption for the third-party administrator business. MORE
The diabetes and obesity epidemics mean more Americans may suffer from heart disease before they turn 65, challenging payers to craft better intervention models that help prevent serious cardiovascular events and increased spending on acute care. MORE
It's a chilling reality often overlooked in annual mortality statistics: Preventable medical errors persist as the number three killer in the U.S. and the source of great waste. MORE
After taking losses of $40 million over three years, BlueCross BlueShield of Western New York is withdrawing from the Empire State's Medicaid managed care program in six of its eight counties of operations. MORE
More and more, health insurance professionals who design consumer-driven and high deductible plans are using them personally, a trend that bodes well for their improvement. MORE
Premiums for exchange plans in many states are set to increase anywhere from slightly to significantly, but there's new competitive pressure coming as the nation's largest insurer starts flooding markets. MORE
After one of its worst years ever, one Blue Cross company is banking on an insider and native son to lead a comeback. MORE
In a region dominated by one insurer and teeming with health systems, accountable care models are gaining provider acceptance but still accumulating evidence. MORE
After quietly building a small insurance unit, one of the nation's largest health systems is launching a new health plan brand that could pose more competition for established insurers. MORE
The healthcare tech boom continues, as one of the most-heralded consumer insurance comparison startups was acquired by an insurance services firm hungry for growth. MORE
Evidence from recent federal enforcement actions suggest pharmacy benefit managers are exposing public-payer managed care plans to problems that could send shivers up executive's spines. MORE
Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option. MORE
Group plans are increasingly expanding their consumer-directed health plans with health savings accounts, after toying with lower deductibles and reimbursement account wrapping. MORE
One of the nation's largest health insurance advocacy groups is welcoming in a new chief executive, amid a tumultuous regulatory environment. MORE
Amid record enrollment in Medicaid and state concerns about the program's budgetary sustainability, the federal government is offering new financial support and policy options. MORE
In California, insurers and regulators are fighting for control of the post-reform insurance market. MORE
With federal rules governing health plan spending looking like they're here to stay, insurers are making inroads on compliance, although they will hope for possible tweaks in the future. MORE
As Affordable Care Act exchanges bring health plans to previously uninsured Americans, there are also market segment transitions that could prove favorable for risk pools. MORE
Trying to help transition the American healthcare system beyond fee-for-service, Blue Cross and Blue Shield companies are starting to reach new reimbursement milestones. MORE
UnitedHealthcare's bid to change financial incentives for oncologists has led to some promising, though somewhat mixed results. MORE
Joining its peers in touting accountable care, Cigna has met a fairly ambitious goal set two years ago, but more time is needed to test the strategy's sustainability. MORE
One regional insurer is using a new approach in provider network management, as it aims to tackle a laborious administrative process. MORE
One of the country's largest health insurers is being accused of having misleading information on doctor and hospital network participation for EPO and PPO plans sold in the state exchange. MORE
With spending on diagnostics alone for cardiovascular disease likely to be a major challenge for insurers amid the baby boom wave, Aetna is turning to an emerging option as part of a strategy to avoid invasive tests and treatments. MORE
The insurer-owned Allegheny Health Network is partnering with a national cancer center to offer new therapies and trials in western Pennsylvania, a sign of heightening regional competition and the emergence of new models for pursuing innovative treatments. MORE
The growth of total U.S. medical costs is slowing down, but one segment is expanding fast enough to catch insurers by surprise. MORE
The Office for Civil Rights, the HHS division responsible for enforcing HIPAA, is slated to get a new director after the official departure of Leon Rodriguez. MORE
As the final chapter of WellCare's fraud saga closes, the company is lining up new executives and trying to grow. MORE
Two years after upholding most of the Affordable Care Act, the U.S. Supreme Court has carved out a new religious exemption for employers, once again bringing women's health into the political fray and potentially adding new complications to group insurance. MORE
The prospect of a near-duopoly healthcare market is becoming a reality, and only time will tell if two giant closed networks are good for both patients and business. MORE
A regional patient-centered medical home demonstration is appears to be prime for expansion of Medicare members. MORE
The Obama Administration wants to make it as easy as possible for the 8 million Americans who bought insurance via an exchange last year to keep their plans. To that end, the auto-enrollment policy Health and Human Services unwrapped aims to reduce complexity for insurers, but it also brings new issues. MORE
Two large players in a small market are going to spend the next three years trying to collaborate with emerging incentives, as shared risk becomes the new normal. MORE
The individual insurance market is now too big to ignore, drawing new crowds on and off state exchanges. MORE
As health plans start serving newly-insured populations and try to improve outcomes for long-time patients, all while taking on more financial risk, the case for aggressively targeting diabetes and obesity has never been greater. MORE
The ambulatory surgery center movement has some evidence to back up arguments for its relative cost-effectiveness, although variation can still be vexing for health plans and patients. MORE
The nation's diabetes and obesity crises have started taking their toll on healthcare spending, and some insurers are stepping in before new generations develop these problems in the long-term. MORE
Just as government marketplaces are transforming their individual policy businesses, Blue Cross and Blue Shield companies are setting up private exchanges to save a far larger source of traditional revenue. MORE
Insurer premiums in the second year of public exchanges look financially wise to credit experts, although there are also some double-edged swords. MORE
Even before federal approval is won for the experimental program, insurers in one large state are ready to start selling exchange plans to Medicaid beneficiaries. MORE
After the botched rollout of insurance exchanges last year, the federal government is trying to get the technology right for what promises to be just as big a consumer turnout this fall. MORE
A new start-up is hoping to become the largest enabler of primary care in the country within six years, by letting independent docs start ACO networks and stay free of the hassle of hospital systems and payers. MORE

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