Value-based care not likely to end payer/provider financial spats

By Bob Herman  |  January 22, 2015

A large payer and health system in California are embroiled in a bitter feud over expired contract terms, the type of fight all too common in the fee-for-service world. Value-based pay promises to align providers and payers in the pursuit of efficient care, but they're likely to keep fighting.

Lessons from Vermont

Lessons from Vermont

By Merrill Goozner  |  January 03, 2015

Sorting through the shards of Vermont's discarded single-payer health insurance scheme reveals the plan was undone by its generosity toward patients, hospitals and physicians, not its core assumptions.

Pricey 'breakthrough' drugs confound Medicaid rate-setting

By Virgil Dickson  |  December 12, 2014

Actuaries say it's getting increasingly difficult to advise states on sound rates for Medicaid managed-care plans because high-priced specialty drugs like Sovaldi continue to hit the market at a rapid clip.

Unless they change, devicemakers may see shrinking profits

By Jaimy Lee  |  October 20, 2014

A leading consulting firm is warning medical-device companies that they either embrace the changes taking place in the global healthcare system or they will face sharply declining operating margins in the years ahead.

UnitedHealth's earnings suggest tame medical spending

By Bob Herman  |  October 16, 2014

UnitedHealth Group's profit per share in the third quarter exceeded Wall Street's estimates in large part because of lower-than-expected medical costs, giving hope for other health insurers that healthcare spending is still being held in check.

Medicare premiums, deductibles won't increase in 2015

By Paul Demko  |  October 09, 2014

Premiums and deductibles for Medicare Part B beneficiaries will remain flat for a second straight year, HHS announced Wednesday. In 2015, seniors with incomes below $85,000 will pay a $104.90 monthly premium and face a deductible of $147.

Rural hospital patients face higher out-of-pocket costs for outpatient services

By Bob Herman  |  October 08, 2014

Medicare patients who receive routine outpatient care such as IV bags and heart tests pay considerably more out of their own pockets at critical-access hospitals than at other general acute-care hospitals, according to a report released Wednesday from HHS' Office of the Inspector General. For some...

Healthcare industry doesn't want unique plan identifiers: WEDI

By Joseph Conn  |  September 29, 2014

When Congress passed the Health Insurance Portability and Accountability Act in 1996, it saw “administrative simplification” as a general benefit and specifically called for the adoption of several national numerical identifiers as a way to boost efficiency, reduce waste and control...

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