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Restricting access to prestigious, long-available providers can sometimes cost insurers long-held contracts and be competitive gains for others. MORE
With uncertainty in Medicare's accountable care program, some hospital systems are scrambling for long-term options and may give insurers a run for their money. MORE
From incentivizing wellness to protecting against catastrophic loss, what's old is new again in health insurance advertising. MORE
Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year. MORE
Call it managed care 2.0. The latest idea in affordable networks is bringing together a large insurer and disparate providers to create a simplified, integrated care system. MORE
What happens when an insurer with the bulk of a state's public exchange membership pulls out? MORE
Before the next open enrollment begins, verification issues are lingering for several hundred thousand consumers on existing exchange plans, leaving insurers and providers facing a range of potential problems. MORE
Narrow networks sparked consumer angst and new government oversight after the Affordable Care Act's first open enrollment period. But now, there's evidence that limited networks can be a win-win, albeit with one primary caveat. MORE
In the latest development of private health insurance exchanges, one large Blue Cross company is betting on the single-carrier model as a way to keep group business, or hopefully expand it. MORE
A joint investment in a health IT company by two Blue Cross companies and a private equity firm is reaping a few billion amid healthcare's tech boom. MORE
Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies. MORE
As proton cancer treatment centers expand, payers and providers may have to collaborate to expand the evidence base, to avoid the highly-expensive technology crowding out other investments. MORE
Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York. MORE
A former Medicare administrator who helped nurture many of the Affordable Care Act's new Medicare regulations is bringing his experience to the private sector. MORE
In branding, sometimes it's worth giving up old ideas and trying new ones, or at least transitioning to new messages when it seems they're not resonating. MORE
What happens when the insurers who flooded exchanges and garnered the bulk of the membership increase their rates? MORE
Health reform is creating a new impetus for regional payers and providers to collaborate on long-standing problems. Medicare is proving to be a good place to start. MORE
UnitedHealth Group's big data venture is plying new waters in deals with several powerful healthcare institutions, trying to create value with one of healthcare's largest databases. MORE
For the many health organizations trying out or diving into accountable care, there are some important ideas from abroad to consider during the next stages of design and evaluation. MORE
Healthcare advocates for seniors are trying to stop a managed care expansion for the country's largest Medicare-Medicaid dual eligible population, in what could be a precedent for other states. MORE
Americans living in rural areas will be a key target as insurers, states and nonprofit groups strategize how to enroll more people in exchange plans this fall. MORE
The currents of health reform and consumerization are getting more treacherous for incumbent hospital businesses, but payers and retailers, especially, have waves to ride. MORE
Aetna's ACO portfolio keeps growing, as the insurer tries to capitalize on Medicare Advantage rate pressure and step in where some competitors face upheaval. MORE
Many insurers setting premiums for the upcoming exchange season seem to be banking on consumer price sensitivity. Some are also poised to draw the most cost-conscious enrollees away from competitors. MORE
Highmark, an insurer with its own health system, is challenging a growing and controversial billing practice that also happens to be a central part of some health system integration strategies. MORE
The pharmacy benefits industry is challenging a new state law, trying to protect a key management tool that insurers, employer groups and public payers have been relying on for cost stability. MORE
Signing people up for health insurance is the easy part of Rawha Abouarabi's job ministering to immigrants and Arab Americans in this manufacturing hub along the Rouge River in Dearborn, Michigan. MORE
For a state trying to get a handle on notoriously high healthcare spending, there are some reasons to be cautiously optimistic and keep following those with the most market power. MORE
Forty years after the creation of a national regulatory framework for workplace benefits at large employers, employee health benefits are in the midst of another evolution. MORE
Another state is being offered a federal waiver to expand Medicaid on its own terms, hoping to bring the efficiency of private insurance and new value incentives to the public payer program. MORE
Healthcare organizations are struggling to get a handle on population health and find the necessary data management tools. MORE
Payers that want to help their members avoid the worst and most expensive experiences with cardiovascular disease now have more evidence and options. MORE
Wanted: A chief executive to lead a 76-year-old insurance company through a jungle of regulatory challenges, legacy business upheaval and new competition. MORE
Clinical integration and accountable care developments in greater Philadelphia are taking a novel turn, with one large insurer teaming up with a new multi-health system collaboration. MORE
The federal government is ordering state Medicaid programs to pay for comprehensive autism services, but some details remain unclear. MORE
As payers continue to look for the best ways to cover cancer treatment, a new study is lending support to the argument for moving away from hospital inpatient settings. MORE
An insurance industry veteran who managed one of the few well-functioning state exchanges in the first open enrollment period is taking a key federal post. MORE
A regional payer-provider dispute over costs and value is showing that troubles can arise amid efforts to design reforms and move away from fee-for-service. MORE
While more payers and providers are trying to pursue value-based reimbursement models, some insurers are finding themselves fighting back against questionable fee-for-service schemes. MORE
The federal government's employee advocate is trying to draw a line in the sand for wellness programs, and raising questions about the value and legality of some employers' incentive-based cost containment strategies. MORE
How much leeway do employers and insurers have in deciding whether they'll cover contraceptives without charge and in determining which methods make the cut? Not much, as it turns out, but that hasn't stopped some from trying. MORE
Over a five-year period, five programs sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network to improve the quality of certain medical and surgical procedures performed in Michigan hospitals, have produced $597 million in healthcare cost savings, and have lowered complication and mortality rates for thousands of patients. MORE
What's in a name? When it comes to health plans sold on the individual market, these days it's often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you're buying by name alone -- assuming you're one of the few people who know what an EPO is in the first place. MORE
The idea of a new "copper" tier of health plans is being pitched for the most healthy and cost-conscious consumers. MORE
One of the most acrimonious disputes of the insurance exchange debut is coming to a close, in a testament to the market influence some providers now have. MORE
Oregon is mandating Medicaid coverage for gender dysphoria treatment, bringing it in parity with the state's progressive commercial market and also putting pressure on other states and insurers. MORE
Insurers may need to find new ways to control costs for specialty drugs, as more states add limits to cost-sharing and utilization continues to grow. MORE
From a real estate perspective, the healthcare landscape is dramatically changing. The massive, monolithic structures that have come to represent the acute care setting are becoming more stratified in smaller buildings across wider swaths of a community. MORE
Among providers trying to get into the insurance game, some are starting off small at the local level, but in a big, growing market segment. MORE
The way blood-based diagnostic tests are performed and paid for could change dramatically if a new company has its way, with the potential to benefit patients and payers at the expense of traditional providers. MORE

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