Managed Care news and information

Physicians could do far more to use prescription drugs more cost-effectively—in some cases, by recommending exercise or better nutrition before prescribing them in the first place, say a team of Dartmouth University researchers. The researchers are calling for more nuanced measures of...
FULL STORY »

Molina Healthcare is entering the South Carolina Medicaid managed-care market by acquiring the medical-home membership in the state from Community Health Solutions of America.
FULL STORY »

The entry of Medicaid managed-care insurers into the exchange market will test whether a broader segment of Americans will accept the economy-class health coverage.
FULL STORY »

HHS has allowed states to spend billions more on Medicaid pilot projects in recent years than the agency's own rules allow, and the problem may grow in the future, according to a new federal audit.
FULL STORY »

The CMS has named nine Pioneer accountable care organizations that will exit the program next year, including seven that have signaled they will enter the Medicare Shared Savings Program model and two that will drop out of Medicare accountable care entirely.
FULL STORY »

A CMS rule issued in early July has set off a scramble among state officials to finalize and submit an application needed to implement their Medicaid expansions allowed by the healthcare reform law. The delay in the rule may push states hard up against the Oct. 1 start of the Medicaid enrollment...
FULL STORY »

For hundreds of thousands of primary-care physicians across the country, the era of unreimbursed evaluation-and-management, or E&M, care may finally be coming to an end.
FULL STORY »

The U.S. will have to do more to prevent chronic illness than simply managing it better in order to save significantly on costs for Medicare's most expensive patients, a new study suggests.
FULL STORY »

Managed care rapidly gained and quickly lost favor more than a decade ago, but even as it lost ground, it never fully lost a hold in the market. Now, it's an increasingly popular option among seniors enrolled in Medicare, and some managed-care tenets—care coordination led by primary care and...
FULL STORY »

Kentucky Spirit Health Plan doesn't have the right to withdraw early from a contract with the state as a Medicaid managed care organization.
FULL STORY »