Politics and Policy

GAO report raises questions about programs for Medicare/Medicaid beneficiaries, but industry insiders remain optimistic.

To participate in Medicare and Medicaid, hospital and critical access hospitals (CAHs) would need to meet new criteria.

The government recently filed lawsuits to block Aetna-Humana and Anthem-Cigna mergers. Here’s how experts say this will impact the industry.

Several lawsuits have been filed by qualified health plans offering coverage on the Affordable Care Act health insurance exchanges.

A new “secret shopper” study shows that problems exist for patients with acute conditions accessing services for patients. Effectively addressing issues of network adequacy may require more accurate provider information.

The Managed Healthcare Executive editorial advisory board says healthcare executives should watch out for these seven leadership deficiencies.

President Obama recently reviewed the ACA. Find out what he said are the top successes, and how policy insiders are reacting.

Clinton and Trump are keeping mum about some healthcare issues, and that’s raising some critical questions. Managed Healthcare Executive asked industry experts to comment on what topics presidential candidates are being quiet about, and why they suspect they’re not talking about them.

Over the next decade, health spending is expected to grow at an average rate of 5.8% per year.

HHS is taking formal steps to address opioid addiction, a widely recognized national public health crisis. Find out the policy changes.

A new KFF issue brief finds that healthcare coverage problematic for some, even as coverage is gained through the ACA.

CMS finalized new rules that aim to enrich the Qualified Entity Program by expanding access to analyses and data that will help providers, employers, and others make more informed decisions about care delivery and quality improvement.

Multiple factors are moving mental healthcare to a front burner issue in managed care.

Health plans have found that Affordable Care Act (ACA) exchange plans are plagued with loopholes, and that some consumers are taking advantage.

Is the republican alternative ACA plan a viable trade-off? Here are some key elements of the plan to consider.

What impact will MACRA have on your organization? We asked experts to tell us.

The first-year results of the ACA’s Risk Adjustment Program are in. Find out how it worked out and what insurers need to do next.

Making these three changes to health insurance exchange plan offerings could attract more consumers and increase the likelihood of success.

The ACA has done a lot of good, but key opinion leaders believe there’s still room for improvement.

Report offers some clues regarding healthcare spending disparities

The ACA risk-adjustment model applies to plans sold in the individual and small group commercial market, including plans sold through exchange marketplaces. Here are four main limitations.

CMS’ Comprehensive Care for Joint Replacement model will hold hospitals financially responsible for the quality and cost of hip and knee replacements.

The industry is awaiting the Supreme Court’s ruling on Universal Health Services v. Escobar. This case concerns the viability of the “implied certification” theory of legal falsity under the False Claims Act.

Creating a national data policy framework for empowered consumer choices.

MACRA, which will further the shift to value-based reimbursement, has industry insiders grappling with the complexities, particularly those related to reporting guidelines for providers.

An expansion of the ACA requires health plans to cover a new preventive service: Regular nutritional counseling for millions of overweight Americans with other health risks.

A new study examines payer payment shifts for opioids.

Colorado could have the first statewide universal healthcare system in the country if proposed legislation passes in November. Will it happen? Experts weigh in.

Insight from Paul Markovich, CEO, Blue Shield of California