Business Strategy

The industry is challenged by a number of issues in 2015 including cost control, technology threats, and the emerging consumer market.

ACOs in Medicare’s Shared Savings Program (SSP) will have three more years before they are liable for losses if rules proposed by the Centers for Medicare and Medicaid Services (CMS) on December 1 are adopted.

As consumers access and act on health plan information, they'll begin seeing them as a trusted source, allowing insurers to tailor engagement to their needs.

Approximately half of all adults in the U.S. have one or more chronic health conditions, and 75% of health care costs are due to chronic illnesses. When psychosocial issues like depression, low income, or lack of social support are present, the impact on costs is even greater.

Employer-sponsored healthcare benefits are not insulated from the changes taking place in the broader healthcare marketplace. However employers, particularly large employers, are attempting to drive the conversation and actions toward issues that are important to them. One of the best ways to do that is to pressure health plans to help them achieve their healthcare goals

Hospitals and health plans need each other and can use this relationship to enable improvements that benefit both parties.

Certain group health plans that don’t provide minimally-defined coverage for in-patient hospitalization services will be disallowed if they were purchased after Nov. 4, 2014, the U.S. Department of Treasury has announced.

Providing first-call resolution through a healthcare plan's call center is critical to customer satisfaction.

After beating third quarter Wall Street estimates and with their stock prices at all time highs, the nation’s leading insurers are expanding their presence on state exchanges (also known as marketplaces) in response to a contracting employer-driven market.

Healthcare spending has climbed from roughly 5% of U.S. GDP to nearly 18% as of 2012, an unsustainable rate of growth that jeopardizes America’s fiscal solvency and long-term ability to support programs like Medicare and Medicaid.

The three giants driving America’s $3 trillion healthcare economy–health insurers, hospital systems, and pharmaceutical companies–all face the same dilemma: how to effectively engage customers to earn trust and improve the consumer healthcare experience.

With more than 40,000 health and wellness apps on the market today, consumers of all ages are responding to health care they can access on-the-go.

When Congress voted in March to push back the ICD-10 deadline to at least Oct. 1, 2015, emotions were mixed from payers and providers across the industry.

Enrollees in health insurance plans that don’t comply with the Affordable Care Act (ACA) have begun receiving notices of cancellation, one year after getting a reprieve.

Group cost sharing in the workplace is gaining in popularity as employers seek to contain costs, according to a new report by Unum, a leading provider of financial protection products.

Narrow network plans will play an increasingly significant role in healthcare, but there are still some wildcards that could impact their success.

The lack of competition for health insurance in U.S. metropolitan markets is a cause for concern for the American Medical Association (AMA).

One day after announcing that customers will now be able to shop and sign up for health insurance including Medicaid in its stores, retail giant Walmart announced that it was cutting part-time health benefits to about 30,000 workers.

The 50-year reign of employer-driven healthcare coverage is coming to an end, according to a new study.

Opportunity abounds for plans that formulate the right stars strategy to capture bonuses and retain and win members

Employers are attempting to mitigate rising costs resulting from the ACA by shifting them to employees, according to a new survey from the Darla Moore School of Business at the University of South Carolina.

Success in today’s health insurance industry may be elusive because of significant market trends driven by the ACA, according to William Lindsay, president of the Lockton Employee Benefits Group.

ACA base standard "relatively tight"

Patient care as well as the financial health of oncologists should be strengthened

Plans tackle cancer treatment

Employees of religious non-profits can receive separate coverage for contraceptive services

Highlights of what executives from Aetna, Cigna and Humana told Managed Healthcare Executive

Growth of accountable care organizations across the U.S. healthcare market is gaining momentum

Exchanges not integrating with Medicaid

Struggling with declining revenue, many providers are turning to consolidation, changing pricing structures and new reimbursement models to protect their revenue