Politics and Policy

An ongoing challenge particular to plans serving duals is a gap between the plans’ reimbursement rates and the health status of the populations they serve.

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.

Data, quality, specialty drug costs and social determinants of health are the pain points that are keeping executives at nonprofit safety net health plans up at night.

People in states that expanded Medicaid under the Affordable Care Act are far more likely to be newly identified with diabetes than in non-expansion states, according to a study published online in Diabetes Care.

The oral arguments in King v. Burwell will determine the viability of a central mechanism of the ACA-tax credit subsidies for economically-eligible citizens.

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.

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

The Affordable Care Act’s medical loss ratio provision yielded more than $5 billion in benefits to consumers from 2011 through 2013, either through the rebates that insurance companies have paid to them or through reduced health plan spending on overhead, according to a new Commonwealth Fund report.

Half of all consumers who received advance tax credit subsidies for health insurance in 2014 would have to pay back a portion of them to the Internal Revenue Service (IRS), according to a new analysis by the Kaiser Family Foundation.

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.

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 nationwide interoperability roadmap released by the U.S. Department of Health and Human Services in January outlines a set of critical actions healthcare players need to take between now and 2024 to get to a fax machine-free future.

Healthcare stakeholders are touting the benefits of transparency, but to see real change, we also need clarity.

A bill has been introduced in California which will require drug companies to reveal operational costs in order to better understand pricing for ultra-high-priced drugs.

Marketplace websites could be doing significantly more to help consumers make informed choices about their health plans, according to a new study.

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.

About 11.4 million Americans signed up for private health coverage under the Affordable Care Act's second open enrollment cycle, the White House announced.

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.

Nearly four in 10 organizations that offer health insurance through state exchanges also operate a Medicaid managed care plan in the same state, offering an opportunity for continuous coverage for low-income consumers.

Two recent studies show that members who obtain health insurance through state or federal insurance exchanges use more specialty and generic drugs than their counterparts in commercial plans.

The new Republican-controlled Congress takes aim at the Affordable Care Act.

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

Measurable goals and a timeline to move the Medicare program towards a value versus volume reimbursement model is being called a "transformative shift" that could redefine how care should be provided, measured and rewarded.

According to the research firm Gartner, Inc., information technology is subject to a five-phase acceptance cycle: a Technology Trigger, Peak of Inflated Expectations, Trough of Disillusionment, Slope of Enlightenment, and Plateau of Productivity. Even zealous advocates of social media marketing (SMM) admit their craft is currently stuck in the disillusionment phase.

With the launch of two open enrollment cycles behind it, the U.S. Department of Health and Human Services has turned its attention to promoting HealthCare.gov with a growing list of partners.

Unlike a traditional formulary, the value-based formulary emphasizes the clinical effectiveness of a drug rather than cost so that if a drug is very effective but expensive, it might still fall on tier one.