House v. Burwell ruling could wreak havoc on ACA marketplace

A lawsuit brought by the House of Representatives that challenges the financing of the Affordable Care Act's cost-sharing reductions could put 7 million Americans' subsidies in jeopardy and therefore risk destabilizing the entire ACA marketplace, according to a report from The Commonwealth Fund.


As remaining CO-OPs struggle with enrollment, Maryland's start-up flourishes

As consumer owned and operated plans (CO-OPs) around the country struggled to remain profitable amid lukewarm enrollment numbers, Maryland's CO-OP has emerged as rare beacon of stability, according to Healthcare Dive.


How House Republicans' budget plan would affect Medicaid

House Republicans' proposed budget plan would have a major impact on Medicaid, cutting funding for the program by a total of about $2.1 trillion over the next decade, according to a blog post from the Center on Budget and Policy Priorities.

Medicare Advantage beneficiaries have fewer preventable hospitalizations

Medicare Advantage beneficiaries experience fewer avoidable hospitalizations than those enrolled in traditional fee-for-service Medicare plans, suggesting that MA plans may be more effective at coordinating preventive care, according to a new study.


Blues plans embrace telemedicine reimbursement

In an attempt to bring more convenient healthcare options to their members, Blue Cross Blue Shield plans across the country are starting to reimburse more telemedicine services.

Highmark CEO: ACA marketplace stabilization requires a community approach

Highlighting the benefits of an integrated health system, Highmark CEO David Holmberg told Trib Live that a "healthcare community" approach to care will bring stability to the Affordable Care Act marketplace.


HHS Office for Civil Rights details HIPAA application to workplace wellness programs

Guidance published this week by the Department of Health and Human Services Office for Civil Rights details how and when the Health Insurance Portability and Accountability Act applies to workplace wellness programs.

Independence Blue Cross to cover telehealth visits

Philadelphia-based Independence Blue Cross is now offering coverage for some telemedicine consultations. 

Reasons to be optimistic about the new Medicare Part B payment models

The federal government's new Medicare Part B payment model proposals have stirred up considerable controversy, but the tests may actually be worth a try in order to tackle the spiraling costs of prescription drugs, according to an opinion piece from STAT.


Humana bases executive pay on member health outcome measures

Amid the industry's shift to performance-based provider payments, one health insurer is taking the trend a step further by tying executive bonuses to members' health outcomes.


Insurers embrace home-care programs to manage patients' health

While insurers increasingly turn to at-home care management programs to improve the health of their senior members and keep them out of the hospital, but some officials are concerned that the trend might be an attempt by insurance companies to maximize reimbursement, according to an article from the Tampa Bay Times.


Customer engagement strategies for pioneering payers

Customers are now more educated, more particular and less loyal than ever before when it comes to their health insurance choices, leaving payers little choice but to adapt their customer-engagement strategies to this new reality, according to a new report from IDC Health Insights.

Feds turn focus to preventing customer churn on ACA exchanges

Now that the Affordable Care Act's third open enrollment period has come to a close, Obama administration officials have turned their attention to ensuring that as few customers as possible drop their coverage.

At AHIP policy conference, leaders talk new payment models, drug prices

During America's Health Insurance Plans' National Health Policy Conference, AHIP President and CEO Marilyn Tavenner said the private sector is taking the lead in the effort to provide better value in the healthcare system. 

Reports break down final ACA open enrollment stats

Two new reports from the federal government provide more details about who signed up for Affordable Care Act plans during the most recent open enrollment period, how they chose coverage and what they paid.


4 ways health insurers can move to a consumer-centric business model

Healthcare under the Affordable Care Act is becoming more customer-centric, and if insurance companies want to succeed, they must move from a purely transactional relationship with their members toward a customer-first relationship, according to an article from Advertising Age.


Struggling CO-OPs enter a pivotal year amid signs of potential growth

Although nearly half of Affordable Care Act consumer operated and oriented plans shut down, and many reported multi-million losses last year, officials say 2016 could be a rebound year for the frequently maligned plans, according to the Associated Press.

A glimpse into the DOJ's review of health insurer mega-mergers

In a Senate oversight committee hearing this week, a federal antitrust regulator offered insight into the closely watched reviews of the pending Aetna-Humana and Anthem-Cigna mergers, noting that if approved, the health insurance deals could be a "game changer" for the industry.

BCBS of North Carolina could face hefty fines for administrative issues

Blue Cross Blue Shield of North Carolina, which continues to grapple with technology issues that have wrecked havoc on its enrollment and billing systems, may be facing $1,000 or more in fines a day per violation, according to an article from the News & Observer.


Senate subcommittee blames CMS officials for funding failing CO-OPs

The Centers for Medicare and Medicaid Service's (CMS) top brass faced another round of pointed questioning from lawmakers regarding failed consumer operated and oriented plans (CO-OPs), targeting new evidence that the agency continued funding the failed start-ups despite signs of financial insolvency.