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CMS may overhaul enrollment process, could include questions about sexual orientation

By Virgil Dickson  |  February 08, 2016

As the CMS seeks to simplify the application process for exchange plans and Medicaid, payers want to make it harder for individuals to sign up after open enrollment ends. Meanwhile, advocates and providers want to reduce barriers and have the CMS learn more about who is signing up, including their...

Plenty of reasons why insurance shouldn't be employer-based, and other letters

By Modern Healthcare  |  February 06, 2016

Regarding the Feb. 1 editorial “The future of employer-based insurance,” finally a rational discussion about this fundamental flaw in our system. There are numerous reasons why we don't need employers picking health plans for their employees, but we do need their money, which in reality...

Tufts operating surplus slips

By Michael Sandler  |  January 29, 2016

Tufts Medical Center reported a drop in its operating surplus for fiscal 2015, as the not-for-profit saw a rise in total operating expenses.

Blog: Incentives for quality a challenge for ACOs

By Melanie Evans  |  January 25, 2016

Pediatricians in an ACO who received small incentives to improve quality did so, but not as significantly as doctors employed by a hospital, a new study found. The findings underscore the challenge that policymakers and the industry face as payers increasingly seek to tie payment to performance.

Maryland's bold payment reforms blaze a path, but will others follow?

Maryland's bold payment reforms blaze a path, but will others follow?

By Melanie Evans  |  January 23, 2016

In 2014, Maryland started to regulate hospital spending after nearly four decades of setting hospital prices for all payers, public and private, giving other states a blueprint for aggressively regulating the way hospitals do business. But following it would require significant political will.

Diabetes treatment innovation raises questions of reimbursement

Diabetes treatment innovation raises questions of reimbursement

By Adam Rubenfire  |  January 06, 2016

One of the nation's leading endocrinologists warns that a so-called "artificial pancreas" touted as a game-changer for the treatment of diabetes could also bring headaches to the industry as it learns how to get reimbursed for advice given in between visits.

Enrollment surpasses 3 million on state and federal exchanges

By Virgil Dickson  |  December 09, 2015

With enrollment surpassing 3 million, the CMS' top official defended the long-term viability of federal and state marketplaces as major insurance companies continue to highlight bleak financial performances for their products on exchanges.

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