Health Management

As the Medicare program and the healthcare industry at large begins the transition from fee-for-service to value-based reimbursement models, health plans are responding by ramping up collaboration with providers to improve health outcomes, especially for medically-complex Medicare members.

Controversy surrounds the 340B Drug Discount Program, and many industry leaders agree that the healthcare law plays a large part.

A significant and growing performance gap exists between dual eligible and non-dual eligible members that cannot be attributed to a health plan's quality of service, a new study by Inovalon has found.

After the first year of Medicaid expansion under the Affordable Care Act (ACA), some healthcare providers and plans on the front lines are confronting operational-as well as political-challenges.

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.

The overwhelming majority of state health insurance marketplace plans are not providing required coverage for smoking cessation, according to a new report from the American Lung Association.

Blue Cross Blue Shield of Michigan's program lowered costs and improved patient outcomes.

Blue Cross Blue Shield of Massachusetts has taken big steps to curb the growing opioid addiction problem.

Provisions of the Affordable Care Act will cost $142 billion less over the 2016–2025 period than originally estimated by government agencies, due to slower premium growth and changes in enrollment sources.

A new, “next generation” accountable care organization model that encourages greater coordination between providers and beneficiaries has been launched by the U.S. Department of Health and Human Services.

The Patient Centered Outcomes Research Institute has awarded Kaiser Permanente $14.4 million to compare strategies for active surveillance of current and former smokers to scan for potentially cancerous small growths in the lungs, including more versus less intensive strategies.

Optima Health, which has seen a 500% increase in individual members since 2013, is using technology processes and platforms to monitor and automate the customer experience.

Making sure its members get the right care at the right place and at the right time drove Independence Blue Cross to launch a two-year pilot program last fall with consumer engagement firm Accolade.

Spurred on by the Affordable Care Act, retailers, health plans and providers are staking strong retail positions that are increasing coverage opportunities and access to care.

A low-fat plant-based vegan diet may help obese children lower their risk of heart disease, finds a new study from Cleveland Clinic.

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

A group of the top U.S. health systems, payers and stakeholders has formed the Health Care Transformation Task Force, a private-sector alliance aimed at accelerating the healthcare industry's transformation to value-based care

Healthcare leaders expect to recoup investments in technology, staff and facilities that support new models of care such as accountable care organizations within four years, according to a new survey.

Envisioning a public health threat, managed care recently notched up its readiness for an Ebola outbreak in the United States. Valuable lessons emerged from the latest effort, adding to the knowledge gleaned from other epidemics, such as the HIV/AIDS and SARS viruses and the bird flu.

Patient-centered care tailored to individuals is needed to treat and monitor the 100 million Americans who live with chronic pain, an independent panel convened by the National Institutes of Health (NIH) has concluded.

Eighty-nine new accountable care organizations will join the Medicare Shared Savings program in 2015, bringing the total number of participants to 405.

The Affordable Care Act has ushered in a new era of convergence among healthcare payers and providers.

More than half of all Medicaid beneficiaries nationwide were enrolled in a managed care organization as of September 2014, according to a new analysis by the Kaiser Family Fund.

Hospitals with high rates of certain hospital-acquired conditions (HACs) will have their Medicare payments cut by 1% for the 2015 fiscal year.

Providers and care teams working to improve the health of overweight and obese patients must keep hypertension detection and management top of mind for this population.

Providers, owners and suppliers who owe Medicare money, have been convicted of felonies or have a history of billing abuse will be excluded from enrollment under new rules adopted by the Centers for Medicare and Medicaid Services (CMS).

Researchers generally agree that intense, highly-coordinated care, with an emphasis on changing patient behavior is a key to improving outcomes and reducing costs for complex morbidities.

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

An estimated 50,000 fewer patients died in hospitals and approximately $12 billion was saved between 2010 and 2013 because of reduced hospital-acquired conditions,according to the U.S. Department of Health and Human Services (HHS).

Total national health spending slowed from 4.1% in 2012 to 3.6% in 2013, the slowest rate of growth since it was first tracked in 1960, according to a report from the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS).