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As cardiovascular disease becomes a greater risk for both older and younger Americans, there may be new grounds for steering members away from traditional diagnostics. MORE
"Isn't that covered by ObamaCare?" Public understanding of the Affordable Care Act has not been great, with a fair amount of confusion about key provisions and benefits detected by surveys. MORE
Insurers that trace their ancestry back to the first days of American health insurance are now facing potentially existential challenges. MORE
Trying to wean themselves off fee-for-service reimbursement, some health systems may be taking a non-committal strategy, dipping their toes in the water before deciding if they want to learn to swim. Insurers should be looking for more than that, if they can offer the right expertise. MORE
Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don't include hospital benefits. Now the administration is concerned too. MORE
Passing a key corporate milestone, UnitedHealth Group is on track to have a banner year, while trying to reshape large swaths of American healthcare. MORE
Where time equals brain in preventing death, disability and millions of dollars in spending, insurers and providers have a huge opportunity to try an approach that can pay for itself. MORE
Insurers are trying to use a new model to improve treatment in costly, difficult chronic diseases like Crohn's, and rationalize reimbursement. MORE
As a microcosm of American health insurance markets, with both old and new regulations and business trends, one corner of the country offers a window into the future. MORE
How did one large employer keep its healthcare costs flat for six years? A wide-ranging wellness program, provider bidding and "enlightened consumerism." MORE
Some health systems are seeing value in becoming part of branded health plan networks for limited provider plans, as other providers try to launch their very own plans. MORE
Tech giant Google is trying out the telehealth waters with a video-based platform that connects consumers searching online for health data with physicians. MORE
It's almost game day for the second season of ACA insurance exchanges, and insurers need to get ready to handle all sorts of consumer inquiries and administrative tasks. MORE
The competitiveness of America's state and regional health insurance markets is once again under question as patients and providers demand greater value propositions from payers. MORE
A new molecular diagnostic approved by Medicare and Medicaid is among the first non-invasive alternatives to colonoscopies, a potential boon for patients and payers but also a new piece of the personalization puzzle to manage. MORE
Cost-sharing in traditional Medicare is on the rise, and benefit designs in Medicare drug plans are changing. MORE
As more providers adpot robotic surgery technology, more information on comparative effectiveness is raising questions about costs and benefits. MORE
The new hepatitis C treatment Sovaldi has driven debate over drug costs for close to a year, but it’s also been a case study in access and coverage in public payer programs. MORE
In one large state, it is up to individual hospitals and health systems to find creative ways to bend the cost curve and best meet local needs. MORE
In a new market for western Pennsylvania healthcare lives, Highmark and UPMC are finding old disputes lurking, adding to consumer confusion amid a new product launch and open enrollment. MORE
Insurers with Medicaid managed care plans can breathe one big sigh of relief, but there are still other things with the insurance fee in Medicaid to worry about. MORE
The industry that prides itself on being at the cutting edge of biomedical research is at the back end when it comes to adopting mobile technology for healthcare professionals and patients. MORE
Insurers that manage long-term care and supports for individuals with disabilities in their home or community will have to assure that beneficiaries can interact with their community and make more of their own life choices. MORE
After years of research, design, pilot programs and technology investment, the movement for quality improvement and pay-for-performance is facing skepticism from outside and within. MORE
Hewlett-Packard revealed on Monday that it intends to break itself into two distinct entities and, in so doing, shared a little about how it will all work. MORE
In Massachusetts, the expansion of the state's largest health system is offering a fractious case study of clinical integration and payment reform. MORE
A few months after opening its own primary care clinics, Walmart is expanding its insurance sales program, in what could be another step toward underwriting. MORE
In the many quests for sound Medicaid reimbursement, healthcare provider advocates may soon have another tool to compel state governments. MORE
Health plans, providers and legislators need to increase the number of primary care practitioners participating in Medicaid as the wait for many to access care is inadequate and getting worse as enrollment mushrooms. MORE
Drug benefits stand as some of the most consequential consumer confusions that can arise in public exchanges, increasing the onus on insurers to improve the design and explanation of formularies. MORE
CVS recently made the bold move of quitting tobacco as part of its retail health ambitions. Now, a chief rival is upping the bet, trying to target consumer incentives and enter a wellness market in flux. MORE
Another health system is taking a step into insurance with Medicare Advantage, banking on seniors wanting access to a prestigious brand. MORE
More and more insurers are getting on to the smartphone and mobile health wave, trying to both attract tech-savvy members and try out new wellness ideas. MORE
Here's a tangled web: It appears that some of the federal government's profit-loss payments to insurers are at once obligated and prohibited. MORE
United Healthcare's shopping spree continues, as it acquires a Texas company with practice management, revenue cycle, physician referral management and other ambulatory-focused technology. MORE
The traditional health insurance business model is on the verge of a cataclysmic shift toward individual consumers. While that will require moving away from the old IT running within many payers, it also makes now a great time for reinvention, venture capitalists argue, if not the only opportunity. MORE
Health insurer spending on treatment for painkiller dependence is on the rise, and proving to be one of several tools needed to curb the epidemic of opioid addiction. MORE
Health insurers are betting on value-based payments, broadly defined, but providers still seem skittish. MORE
Don't rule out chaos for next year's ICD-10 deadline, or maybe plan on it, if the latest readiness research is any indication.  MORE
Rethinking how it acquires information technologies seems to be giving one insurer an edge, letting it eke out a "trifecta" of lower costs, fewer unhappy customers, and increased revenue. MORE
Network adequacy concerns are starting to generate renewed interest in new health plan provider mandates. MORE
The parallels between the nation's ICD-10 switch and the popular fantasy epic are real. MORE
Advances in molecular and genomic technology are creating a maze of new options for payers and patients replete with quite a few meaningful improvements as well as some dead ends. MORE
The ranks of Medicaid are reaching record levels, giving payers and providers, especially, new opportunities. MORE
The backlash against narrow networks continues, as more displeased individual health consumers take their grievances to the courts of law and public opinion. MORE
In bundled payments, where once there was so much promise, there is now conflicting evidence. MORE
The stakes for improvement and innovation are high in American cancer care, and insurers are trying to wield some of their influence to get a return on investment for their members and their budgets. MORE
The Affordable Care Act's rate review is turning out well for consumers, according to the federal government, and although insurers may not be stoked about the new administrative work, it doesn't seem to be scaring them away. MORE
A shrinking number of Medicare Part D drug plans is set to bring beneficiaries some more low-cost choices, but also some potentially confusing benefit designs. MORE
Federal trade regulators have proven their willingness to go after hospital consolidation. Now, they're raising some new concerns about an up-and-coming insurer strategy. MORE

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