Managed Care news and information

As more hospitals and physicians have money on the line for healthcare quality and cost, their attempts to control costs have grown more intense and ambitious. This would be good news if the path to more effective and less costly care were clear, but it's not. That has transformed many of the...
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A lawyer fired by the state Human Services Department says she was let go because of her criticism of an audit of government-funded mental healthcare, according to a lawsuit against the state agency.
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The American Academy of Family Physicians reports that there are only six states at this point where primary-care physicians are receiving enhanced Medicaid managed-care payments under the healthcare reform law to bring them up to Medicare payment levels.
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The reform law relies heavily on expanding Medicaid eligibility, but the implementation of higher Medicaid fee-for-service rates for doctors has been a slow process.
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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...
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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.
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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.
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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.
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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.
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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...
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