Business Strategy

We asked healthcare experts and analysts how the move to value-based care will affect prior authorizations. Here's what they said.

Working in partnership with Doctor on Demand, Optum’s NowClinic and American Well, UnitedHealthcare is expanding its telemedicine reach to encompass 20 million enrollees.

Wellness programs are a strategy to control rising healthcare costs, but according to a recent survey, many wellness incentives are meaningless to participants.

The revocation of Blue Shield of California's tax-exempt status raises the question of whether for-profits have a competitive advantage.

The Supreme Court recently held that the North Carolina Dental Board was not insulated from federal antitrust liability under the so-called “state action” doctrine when it engaged in anticompetitive conduct to restrain non-dentists from performing teeth whitening services.

A new survey from KPMG of 270 healthcare professionals found only 10% are using advanced tools for data collection with analytics and predictive capabilities.

Blue Cross and Blue Shield will launch a health insurance exchange this summer that will support employers’ efforts to help retirees transition from group health benefits to individual Medicare coverage that starts Jan. 1, 2016.

L.A Care Health Plan is filling a void in California for unbanked consumers who need to maintain mandated health insurance coverage but have no credit or debit account.

Change has proliferated how health insurance is offered in recent years, and experts predict that private exchanges will now seek to emulate the e-commerce format that public exchanges have embraced.

After several years of uneven progress, the pace of healthcare payment reform shifted into high gear in January when the U.S Department of Health and Human Services (HHS) announced plans to tie 30% of traditional, or fee-for-service, Medicare payments to quality or value alternative payment models by the end of 2016, and 50% by the end of 2018.

There might be a reprieve if the Supreme Court overturns the ACA's tax subsidies offered on federally-facilitated exchanges.

UnitedHealth Group’s announcement that its free-standing pharmacy care services business, OptumRx, will merge with Catamaran Corp., the fourth largest pharmacy benefit manager in the U.S., makes sense, according to industry experts.

A majority of Americans have compared prices before getting care and most want to do so, but access is still a barrier.

Many employers that offer generous health insurance packages are not looking forward to 2018, when the so-called Cadillac tax will impose a 40% penalty on high-cost health plans.

Public and private insurers are seizing the opportunity to devise programs that promote preventive care and positive behaviors.

The percentage of employers and plans offering wellness incentives is steadily rising, and program designs are becoming more diverse.

With a more consumer-oriented health insurance industry evolving amidst landmark regulatory and technological changes, insurance plans need skills that have never before been demanded.

Recognizing the potential impact of customer loyalty programs on local economies, Medical Mutual of Ohio has rolled out a program that rewards employees for 'buying local.'

Consumer-driven healthcare has transformed from media buzzword to meaningful action, but it’s the economics behind the healthcare universe that have finally turned the consumer-driven concept into a reality for benefits administrators, employers and consumers alike.

While one study finds up to 80% of mid-sized employers are increasing the employee share of health insurance deductibles and co-pays, another finds the amount of employee contributions has declined in the past few years.

Health insurer Aetna will increase the minimum hourly wage to $16 an hour and enhance medical benefits to lower out-of-pocket costs for employees, the company announced Monday.

CMS' guidelines are helping Medicare Advantage organizations to develop and implement member rewards programs that improve health and prevent injury and illness.

2014 was a good year for health insurers, but there are issues in 2015 that could dramatically disrupt the industry’s recent smooth ride.

Today, rating systems are driving consumer decisions in virtually every U.S. industry. A single “gold standard” for customer ratings has yet to emerge in healthcare, and providers and payers are focusing more than ever before on the customer experience – how patients evaluate everyday interactions with their care and service providers.

Cigna/Safeway study finds that patients make cost-conscious choices when provided with education and online shopping tools

In a shift from fee-for-service to value-based care, UnitedHealthcare has launched a pilot bundled payment model with the University of Texas MD Anderson Cancer Center for head and neck cancers.

Medicare Advantage (MA) members in Humana’s accountable care programs in 2013 had 7% fewer emergency room visits and 4% fewer inpatient hospital admissions than members in traditional, fee-for-service settings.

Looking to capitalize on California’s decision to expand Medicaid, Blue Shield of California has purchased Care 1st of Monterey Park, which will add 473,000 Medicaid managed-care members to its rolls.

Now that the ACA has eliminated pre-existing conditions, payers have taken on many unknowns when evaluating the massive population of new members coming in from the state and federal exchanges.

Of all the information technology available to hospitals and practices, the patient portal can be especially challenging.