Today’s Headlines ▶

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
In the debate over provider networks, broad access has been the goal of many patient advocates, but some are also warning of unintended consequences of over-regulation. MORE
The Affordable Care Act is boosting short-term finances for insurers and providers alike. Long-term, though, traditional business models appear untenable and health organizations must evolve to remain sustainable. MORE
A once-promised truth in pharmaceutical benefits management is unravelling, leaving payers exposed and researchers scratching their heads. MORE
Long heralded by technologists, telemedicine is increasingly in demand from consumers. But as insurers warm to reimbursing the service, challenges loom in attaining healthy return on investments. MORE
In the new health insurance economy, where individual consumers have more and more choices, a health plan's brand is one of its biggest asset. Sometimes it has to be changed. MORE
As more companies migrate to self-funding, insurers are trying to meet demand with better outsourced management and new stop loss products. But a few startups with radical ideas are trying to beat them, offering new services to capitalize on frustration with the status quo. MORE
Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D. MORE
Of all the health organizations working as Medicaid managed care plans, a good number of provider-based plans are thriving, sometimes in places where traditional Medicaid HMOs are not. MORE
Along with the changes and new costs coming with health reform, past problems are cropping up for some insurers, even setting regulatory records. MORE
The employer wellness movement is gaining steam globally, but some trends are hitting a wall. MORE
One state is finding new approaches to managing Medicaid frequent fliers. MORE
Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come. MORE
Pretty soon, 24/7 digital access to a physician or nurse practitioner could be a standard health plan benefit. MORE
Walmart is taking another, bigger step into American healthcare with new primary care services. Is a health plan next? MORE
The diabetes crisis and pay-for-value evolution are coming to a head, helping change provider reimbursement in Medicaid. MORE
There's been a lot of talk about compliance lately. Federal and state regulations. HIPAA regulations. But, if you're in charge of healthcare security, compliance is far from sufficient, according to one large insurer. MORE
Access to prices and just a bit of nudging seems to not only help members find the best deals on elective health services like imaging but also spur some competition among providers. MORE
At a time when states are both reforming Medicaid and expanding managed care, insurers have a lot of opportunities to grow business and increase value, but also many challenges. MORE
Startups and investors from Silicon Valley to the Charles River are chasing after the next paradigm-shifting blockbuster innovation. But are any of new companies developing technology that will truly help transform healthcare? MORE
Two large health insurers are hoping a new "public utility" patient data sharing service will improve one of the most pernicious problems in American healthcare. MORE
A venture by Independence Blue Cross and a company ranking well in Warren Buffett's portfolio is getting underway, in an ambitious attempt to optimize the benefits of primary care. MORE
One of the largest Medicaid managed care expansions has been given the green light for what will be a test of reducing public-payer spending. MORE
As provider power grows and integrated healthcare becomes a central goal, the time may become ripe for more payer takeovers of a kind not seen before. MORE
Premiums for exchange plans in California are looking pretty affordable. Is this because insurers are fearful of a rate review process that might be approved by voters in the fall, or a large, diverse market spreading out risk? MORE
Well, here we are. The revised compliance date for providers, payers and clearinghouses to transition to ICD-10 has been finalized by the Department of Health and Human Services. MORE
Utah's start-up health plan is offering a new service that could prove attractive to employers and individuals in a state with a growing tech hub, while also putting pressure on established players. MORE
More and more, insurers are trying to help members get fit, slim down, and eat better. But for one of this century's most pernicious health problems, some find they need data-driven frameworks to target interventions and gauge their effectiveness. MORE
The San Francisco Bay area is getting a new accountable care organization courtesy of the formation of a new company by two healthcare powerhouses in the region. MORE
A new portrait of the uninsured and newly-insured is emerging, with a confluence of factors shaping who is and isn't enrolling in Medicaid or private plans. MORE
Among the many challenges in year two of federal exchanges, the process of auto re-enrollment is bringing the potential of convenience and disruption, for both consumers and insurers. MORE
As payers and employers put pressure on providers to assume more financial risk, providers are struggling to assess the impact of the risk they have already assumed. MORE
Lawmakers, taxpayers and health organizations concerned about Medicare's sustainability can breathe a small sigh of relief, if not hold their breath. MORE
Insurers trying to ride the wave of private exchanges need to be careful not to get swept up or knocked overboard amid varying business models and high customer expectations. MORE
Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans. MORE
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
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

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