What will “bigness” do to healthcare?
Insurance mergers and hospital consolidation will transform the healthcare landscape but how will it affect consumers?
What’s the outlook for 2017 employee healthcare costs?
Moderate cost trends in the large-employer market seemingly contrast with those in the Affordable Care Act’s online marketplaces.
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When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
HHS urges states to help ex-prisoners sign up for Medicaid
Prisons and jails, burdened with ineffective computers, understaffing and complicated Medicaid enrollment procedures, have been slow to sign up released inmates.
CMS tightens rules for Medicaid managed care plans
The sweeping regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how UnitedHealthcare, Aetna and other large contractors who administer care for some of the most vulnerable patients do business.
In ACA backlash, some large insurers induce brokers to avoid high-cost members
Stung by losses under the federal health law, major insurers are seeking to sharply limit how policies are sold to individuals.
After health law experiment fails to show savings, an analysis of what went wrong
HHS’ demonstration may have helped clinics identify patients with pent-up medical needs, causing the spike in treatment and costs, analysts said. Poor people served by federally funded centers often have trouble getting medical care.
How Baptist Health System made Obamacare work
To understand how the health law is supposed to fix the mediocre, overpriced, absurd medical system, you could read wonky research papers on bundled payments and accountable care organizations. Or you could look at what’s going on at Baptist Health System in San Antonio. Under the potent lure of profit, doctors, nurses and managers at […]
A ground-up look at the Medicaid managed-care reforms debate
A look at how insurance companies operating in Tennessee will be altered by these reforms give a window to the bigger Medicaid managed care changes.
Employer-sponsored health insurance gets ‘skinny’ as 16% of firms offer bare-bones plans
Nearly one company in six in a new survey from a major employer group plans to offer health coverage that doesn’t meet the Affordable Care Act’s requirements for value and affordability. Many thought such low-benefit “skinny plans” would be history once the health law was fully implemented this year. Instead, 16 percent of large employers in a […]
CMS is on a $10B search for the next big health insurance innovation — but is it going anywhere?
Affordable Care Act was supposed to mend what President Barack Obama called a broken health care system, but its best-known programs — online insurance and expanded Medicaid for the poor affect a relatively small portion of Americans
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Here’s what hospitals’ & insurers’ Q2 earnings say about where healthcare spending is headed
Analysts who fear health spending is accelerating got plenty of evidence in Wall Street’s second-quarter results to support their thesis. But so did folks who hope spending is still under control. Now everybody’s trying to sort out the mixed message. The answer matters because deficit debates and affordability concerns revolve around forecasts that health spending will […]
Will healthcare reform finally bring primary care doctors the respect they deserve?
BALTIMORE — A few years ago it struck the D.C. region’s biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar. CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in […]
Coaxing the sickest employees to the exchanges: An employer insurance trend in the making?
Can corporations shift workers with high medical costs from the company health plan into online insurance exchanges created by the Affordable Care Act? Some employers are considering it, say benefits consultants. “It’s all over the marketplace,” said Todd Yates, a managing partner at Hill, Chesson & Woody, a North Carolina benefits consulting firm. “Employers are […]
Decoding the high-stakes debate over Medicare Advantage cuts
Health insurers often try to influence Washington through quiet persuasion in plush offices. To fight potential government cuts for private Medicare plans, however, they’ve hit the streets. The Obama administration has proposed reducing what insurers collect for Medicare Advantage plans — HMOs and PPOs, mainly — that cover about 15 million seniors. (Regular Medicare, which […]
Denver actuaries will be the first to know the real cost of Obamacare
Now that medical insurers must accept all applicants no matter how sick, what will these new customers cost health plans? How will they affect coverage prices for 2015 and beyond? Few questions about the Affordable Care Act are more important. How it all plays out will affect consumer pocketbooks, insurance company profits and perhaps the political […]