Price and utilization are the two basic components of the nation's healthcare tab, and wild differences in prices for common medical procedures appear to be driving it up.
A new federal rule will encourage states to ramp up auditing of Medicaid managed-care insurers, many of which keep their medical spending hidden from public view.
Insurers that pull out of the Affordable Care Act marketplaces can nudge enrollees to follow them but can't automatically sign them up for off-exchange plans. The CMS issued guidance on the matter just days after UnitedHealth Group said it plans to ditch the exchanges in most states.
UnitedHealth Group CEO Stephen Hemsley said Tuesday the health insurance and services conglomerate will pull out of most of its Affordable Care Act marketplaces. But the company won't bail on the exchanges completely and will sell individual plans in a “handful” of states.
UnitedHealth Group has already ditched its Affordable Care Act health plans in three states, but a new analysis shows that even if the health insurance conglomerate exited all of its markets, the negative impact to competition and premium prices would be limited to confined areas.
More private insurers are paying for telehealth services, but Medicare still has restrictive rules for telehealth payment. Insurance, provider and technology groups are stepping up lobbying efforts to pass legislation that will force Medicare to provide greater financial support for the service.
Mary Brainerd, CEO of HealthPartners, discusses her system's foray into insurance, the challenges faced by providers that want to make similar moves and her own experience in the healthcare system as a patient with breast cancer. She spoke with Modern Healthcare reporter Bob Herman.
Ahead of the Iowa presidential caucuses, the spotlight is on arguments over the Affordable Care Act. But many providers, patients and public officials in the Hawkeye State are more immediately concerned about Gov. Terry Branstad's shaky Medicaid privatization effort.
In light of the challenges seen since President Nixon launched the first "war on cancer" in 1971, experts say any new approach to cures, moonshot or otherwise, must get back to the basics. The oncology community agrees a coordinated approach could address the clinical research challenges.
Aetna's departure from AHIP months after UnitedHealth Group bolted is further evidence that the large national insurers are increasingly happy to fight their own battles on Capitol Hill, such as shepherding their pending mega-mergers and negotiating changes to the ACA marketplaces.
The CMS faces a daunting task in finalizing regulations for health plans sold on the federal exchange in 2017, given insurance and business groups' strong pushback to the agency's proposed rules issued in November.
The liberation of long-hidden data on what private insurers pay for medical services may increasingly put providers in an unflattering light as they bulk up through mergers and acquisitions.