Politics and Policy

From Blue Shield of California's recently-announced purchase of a Medicaid plan to Partners HealthCare's hard-fought effort to fold more hospitals into its Massachusetts health system, the volume of mergers and acquisitions in the healthcare sector has steadily climbed and now exceeds M & A activities in all other U.S. industries. The surge is being fueled by payers and providers seeking new business opportunities in the post-ACA healthcare market, and 2015 is on track to be another record-breaking year.

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.

Nearly a year after two medical societies released a national consensus statement on the safe prevention of certain C-sections, broad consensus seems to boil down to this: Steps must be taken to lower C-section rates in the U.S., and strong outreach to ob/gyns is critical for success.

CMS Administrator Marilyn Tavenner, a life-long public health advocate tapped to lead the $820 billion federal agency, will step down from her role at the end of February.

Arkansas and Iowa, two GOP-led states, have received approval for customized options for Medicaid expansion that include cost-sharing provisions for beneficiaries.

The U.S. House of Representatives passed two bills this week affecting employer mandate reforms that are part of the Affordable Care Act (ACA), but one is headed for a veto if it clears the U.S. Senate.

About 87% of all enrollees during the first month of open enrollment on healthcare.gov were eligible for financial assistance, compared to 80% during a similar time frame in 2014.

Texas, which has almost 1 million residents in the coverage gap, has inquired about Medicaid expansion, while Arizona faces a renewed challenge to its existing expansion program.

The Centers for Medicare and Medicaid Services announced that it has selected Accenture Federal Services for a five-year, $563 million contract to continue Accenture’s work on the federally facilitated marketplace in support of healthcare.gov.

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.

The number of states deciding to pursue some form of Medicaid expansion continues to grow, with Alabama, Alaska, Florida, Tennessee and Wyoming moving forward or indicating intent to pursue an alternative plan.

Customers at 7-11 stores who use a bill-paying system will receive information promoting the Affordable Care Act’s open enrollment period on their printed receipts, allowing HHS to reach financially underserved consumers.

Almost 2.5 million consumers signed up for health insurance through December 15 as part of open enrollment, and 48% were new consumers.

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.

The implementation of the Affordable Care Act (ACA) stands to alter the U.S. healthcare system and the role of private insurance.

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.

In at least 37 states, the three largest insures account for 80% of total health plan enrollment, according to a new study by the U.S. Government Accountability Office (GAO).

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).

The launch of the Small Business Health Options (SHOP) marketplace drew 200,000 visitors during the first week of open enrollment.

The 2014 deadline for eligible hospitals and critical access hospitals (CAHs) to attest to meaningful use of electronic health records (EHRs) has been extended to December 31 by the Centers for Medicare and Medicaid Services (CMS).

Opposition to the Affordable Care Act (ACA) may explain why two pairs of states had very different performance outcomes in the federally facilitated marketplace (FFM) during the first open enrollment period.

Considering the challenges they faced during the first open enrollment period, Consumer Operated and Oriented Plans (CO-OPs) overall are doing very well, having signed up some 450,000 members across the nation, or 18% of all ACA exchange plan enrollees to date.

As many as 7 million new enrollees could sign up for health insurance during the Affordable Care Act’s second open enrollment cycle which begins November 15, according to the Congressional Budget Office (CBO).

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