Court rulings could give states more health exchange power--for better or worse

Legal challenges are giving states and their governors more power to run healthcare insurance coverage programs, an unintended result of the ACA. "There's a question of whether the individual market would be stable in states without subsidies," Larry Levitt, a senior vice president at the Kaiser Family Foundation, told the National Journal

Can insurers gain market share by cutting premium rates?

As more insurers release their 2015 premium requests, some hope to gain a larger share of their market by dropping their rates. Kaiser Permanente, for example, sold some of the most expensive plans on the health insurance exchange in California and came in fourth among all exchange insurers. Its poor performance may have driven the company to lower its rates by 1.4 percent, reports the Los Angeles Times

3 steps to reduce Medicaid churn

With the Affordable Care Act providing broader access to insurance, states and insurers are both working to prevent new health plan members from coverage disruptions when they transition between different plan types. Read for three steps states and insurers can take to reduce churn.

Physician-run ACO saves $22M

One accountable care organization agreement between Medicare and a group of Florida doctors has saved $22 million in one year, according to the American Academy of Family Physicians. 

Aetna, Cigna report falling enrollment in ACA plans

At least two of the nation's largest insurers say enrollment in health insurance exchange plans has fallen over the summer--calling into question previous claims that almost all who enrolled on the exchanges were paying their premiums.

Anthem Blue Cross pays family's medical bills

Nevada Health Link and Anthem Blue Cross teamed up to iron out some mistakes and technical problems that kept a Las Vegas family from getting claims covered since early this year, reports the Las Vegas Review-Journal.

New program aims to fix broken healthcare system

The Affordable Care Act aims to fix America's unstable healthcare system by improving care and cutting costs. Healthcare reform created the Center for Medicare and Medicaid Innovation to fix the broken system but critics aren't sure its effective, according to MedCity News.

Humana CEO: We need technology innovations 'biting at our heels'

Technology will make some aspects of healthcare less expensive and others more costly, but increasing competition will keep the industry on its toes, Humana CEO Bruce Boussard says in an interview with Fortune.

Massachusetts won't switch to

Massachusetts will have a state-run health insurance exchange after all, and won't have to switch to the federal site, officials announced Friday. CMS approved software customized for the state by tech firm hCentive in tests Thursday, clearing the way for enrollment to begin Nov. 15.

Even small businesses feel heat of employer mandate

Under the Affordable Care Act, employers with fewer than 50 employees are not required to offer healthcare their full-time employees. But small businesses still face challenges as a result of the employer mandate.

How payers can harness the 'wild world of digital' in the new consumer marketplace

I had the pleasure of recently hosting a dinner, sponsored by FierceHealthPayer, with insurer and provider executives. The group talked frankly about how the healthcare industry can best transition...

Few eligible Part D enrollees receive drug therapy management

CMS requires that all Medicare Part D plans offer medication therapy management (MTM) to eligible consumers. But only 11 percent of those who are eligible for the service receive it, finds a new analysis from Avalere Health. 

Is reference pricing in line with ACA goals?

While many health economists embrace reference pricing as a way to reduce rising healthcare costs, some consumer advocates are skeptical.

3 ways to build an effective complex care management program

A new issue brief from the Commonwealth Fund offers several suggestions for creating an effective complex care management program, including choosing a model, working with patients and providers, and sharing patient data. 

High cost of drugs price HIV and AIDS patients out of health insurance policies

Advocates have accused some insurers of discouraging HIV and AIDS patients from obtaining coverage under the ACA by levying high co-insurance charges for expensive prescription drugs. But soaring costs set by drug manufacturers and the number of new enrollees with specialty medicines is putting pressure on payers.  

Blues plan proves even dominant insurers can offer lower premiums

Although Blue Cross Blue Shield of Tennessee monopolizes the state's health insurance market, it still offers very low premiums for plans it sells on the health insurance exchange.

90% of uninsured Americans won't face fines

Almost 90 percent of the 30 million uninsured Americans won't face a penalty due to an increase of exemptions in the healthcare reform law, which leaves insurers to worry about their risk pools, reports the Wall Street Journal.

Uninsured rates drop in states expanding Medicaid, running own exchange

Insurers operating in Arkansas and Kentucky are probably pretty happy, given that those states recorded the largest reduction in uninsured residents since the health insurance exchange enrollment season, according to a new Gallup poll.

IRS providing correct subsidies for exchange shoppers

The Internal Revenue Service correctly calculated subsidies for consumers shopping on the health insurance exchanges, according to a new audit report released to the public this week from the Treasury Inspector General for Tax Administration

Survey: 78% of companies worldwide support wellness programs

In further evidence that insurers should build and promote wellness programs to their large market groups, 78 percent of companies throughout the world are strongly committed to creating a workplace culture focused on health, according to a new survey conducted by Buck Consultants.