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This infographic shows how the small employer market has a lot to gain by from private exchanges. MORE
After finding one state shifting millions in Medicare-Medicaid dual eligible costs to the feds, Medicare's watchdog suspects more may be doing the same. MORE
The Congressional Budget Office has revised its estimates of the Affordable Care Act's costs, with results favorable to the Treasury. However, it also now predicts more premium and network turmoil. MORE
Highmark sees a market for guiding the millions of American adults helping their aging and ill parents, relatives and friends. MORE
When it comes to security threat severity, the Heartbleed bug doesn't miss a beat, and may not for some time. MORE
As payers on behalf of states and the federal government, Medicaid managed care organizations have the potential to drive reforms, and if they don't, they could be on the chopping block. MORE
Centers for Medicare & Medicaid Services leaders point to seniors' wide array of Medicare Advantage and Part D choices as evidence of the program's and insurer's health, but regulators may soon be terminating dozens of plans, unless sponsors pull out first. MORE
Sometimes the best solution is the simplest one. That's what some payers are finding out, for instance, with a home monitoring solution that tracks activity, rather than vital signs, for seniors and their caregivers. MORE
Many startups and companies from other industries have physicians, hospitals, insurers and medtech manufacturers in their sights, betting that they can offer better services at cheaper prices for dissatisfied consumers. MORE
Stuck with exchange software too flawed to fix, Maryland Health Connection leaders are choosing a novel solution that paves the way for other beleaguered state exchanges to seek help from their better performing peers. MORE
The market for commercial full-risk insurance is slowly declining amid the rise of self-insurance, but a few large nationals, the Blues and some integrated care plans are still seeing healthy business. MORE
New public insurance exchange enrollees are starting to use their prescription drug benefits, and so far their per-member costs are looking higher than in the average commercial plan. MORE
Independence Blue Cross and DaVita HealthCare Partners are launching a new joint venture aiming to personalize, improve and ultimately reduce costs for chronic disease care in one of the country's most expensive healthcare markets. MORE
The Centers for Medicare & Medicaid Services is easing back on some of the reductions to Medicare Advantage, although the negative impact could still be as much 3 percent for some insurers and many changes loom beyond 2015. MORE
Competition from provider-owned health plans is increasing, with one of the country's largest national health systems scooping up an HMO in the South that could be a platform to enter other markets. MORE
With about seven percent of all public and private health insurance claims paid incorrectly, insurers have a ways to go, beyond traditional models, if the healthcare spending crisis is to be reined in. MORE
Patients don't fill first-time prescriptions nearly one-third of the time, which makes "nonadherence" an important factor working against proper disease management. MORE
Health plans must calculate what they will charge for 2015 exchange plan premiums despite the lack of detailed data from the just-ended enrollment window. Rate filing deadlines are fast approaching: May for some states and June for those using the HealthCare.gov marketplace. MORE
As more employers seek to integrate workers compensation into benefits packages, a range of market trends and regulations are slowing what could be a natural fit. MORE
Michigan, the federal government and some of the country's largest insurers are getting ready to test key ideas about how to improve healthcare for some of the most vulnerable Americans. MORE
Trying to help new members prevent serious events or chronic conditions, one insurer is offering a reward system that may make health risk assessments more palatable, while also creating a window into the health of a new population. MORE
The Obama Administration may be cheering the landmark enrollment number of 7.1 million, but insurers selling public exchange plans and operating Medicaid organizations should be prepared for a fair amount of turnover. MORE
With the delay in ICD-10, many insurers now have to slow down a mammoth IT project and, potentially more disruptive, make adjustments to a whole slew of programs and contracts. MORE
The recent IPO of Castlight Health shows a huge need for solutions to healthcare's shopping conundrum, especially among employers. But why is consumer buy-in still limited? MORE
A long-time investment banker will be Humana's next CFO, the second recent executive hire from outside the health insurance industry brought in to help with an integration and retail strategy. MORE
Just like that, the massive code set conversion won't happen before Oct. 1, 2015 unless President Obama derails the legislation. MORE
New York is poised to solve one of the most pernicious consumer healthcare billing problems, and regulators think it could be a model. But for insurers, the new process may or may not be the ideal solution, especially when paired with new network requirements. MORE
A group of chiropractors went to war with the Blues and it seems they’ve won, successfully using a novel legal theory that now has lawyers setting their sights on other large insurers. MORE
Kaiser Permanente is hiring an integrated care specialist but organizational outsider as its new chief medical officer, as the focus on innovation comes to the fore. MORE
As the Affordable Care Act continues to disrupt the health insurance industry, health plans must broaden their definition of risk as they calculate rates and attempt to better understand their members' needs. MORE
As the quality and cost transparency movements gain support within the healthcare industry, a more important question persists: what will actually work for consumers? MORE
The many moving parts in the government's ACA plan transition policies are creating a range of new complexities for premium pricing, member pools and the new risk-sharing programs. MORE
Only five states states are making headway bringing more price transparency to healthcare markets, but they could be a model for others, especially those with all-payer claims databases. MORE
The relationship between payers and providers has often been adversarial, but healthcare reform has been changing that, leaving former adversaries trying to figure out how to create new partnerships. MORE
The federal government is promising that anyone who wants to buy subsidized insurance will be able to as long as they try to enroll before March 31. But insurers should expect more surprises and lingering work from complex cases. MORE
The executive who ran IT for Coca Cola is coming to WellPoint to oversee and optimize technology across health plans and other, evolving businesses, including one advanced project with high expectations. MORE
With a new study of Independence Blue Cross members, evidence on the effectiveness of the patient-centered medical home is swinging back towards the positive. MORE
Aetna has won a huge state contract in Texas, pulling away 415,000 lives from Blue Cross Blue Shield and with them several billion dollars in revenue. MORE
What's driving the highest per capita healthcare spending in the country? A half-decade's worth of government-funded research points to some contentious and perhaps uncomfortable trends. MORE
Physicians groups want to preserve a key antitrust exemption for self-referrals under Medicare that the Obama Administration hopes to end for a number of costly services. MORE
Health insurers can expect an increasing number of consumer education challenges around prescription drug management, as utilization controls are more prevalent in public exchange plans than in typical group insurance. MORE
With open enrollment coming to a close, public insurance exchanges are starting to look like they won't be the money-loser many have been girding for, at least for WellPoint's health plans. MORE
Amid problems ranging from the minor to the extreme, at least half a dozen state exchanges are offering enrollment extensions of sorts, but only one is pushing federal limits and trying to extend open enrollment. MORE
Grab a photograph. Any photo. Then take it to a photocopier, and copy it.  MORE
A central hypothesis underlying the case for health reform's insurance expansion is being challenged by new evidence, as the quest to reduce emergency visits and spending continues. The research also highlights ongoing concerns about primary care access. MORE
The largest national dual eligible demonstration project is taking a belated start in California, amid concerns from patient advocates. The concern surrounding the project indicates that new managed care plans have a long way to go, both in fixing problems in the system and getting buy-in from beneficiaries. MORE
As Congress tries to reform Medicare, the program's independent advisor has its own suggestions, including a call to end to what has become a revenue buffer for many hospitals and an integral part of their physician acquisition strategies. MORE
As Oregon transforms how it delivers care to 780,000 Medicaid patients, it hopes to generate better outcomes at lower costs. The problem is these goals conflict with hospital's traditional reliance on revenue from ER visits and inpatient stays. MORE
Federal regulators are starting to finalize simmering ideas for public exchanges and also responding to consumer concerns, outlining a new quality rating system and proposals covering everything from narrow networks to loss ratios. MORE
The days of cryptic invoicing are coming to an end for healthcare, or at it least they should be, financial experts say. MORE

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