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Medicaid's unmanaged managed care

By Bob Herman  |  April 30, 2016

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.

UnitedHealth can invite customers to follow them off the exchanges

UnitedHealth can invite customers to follow them off the exchanges

By Virgil Dickson  |  April 26, 2016

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 will drop out of most ACA exchanges

UnitedHealth will drop out of most ACA exchanges

By Bob Herman  |  April 19, 2016

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.

What would happen to the ACA's marketplaces if UnitedHealth bailed?

By Bob Herman  |  April 18, 2016

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.

Virtual reality: More insurers are embracing telehealth

Virtual reality: More insurers are embracing telehealth

By Bob Herman  |  February 20, 2016

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.

'Don't think you can turn into or develop a health plan on a dime'

'Don't think you can turn into or develop a health plan on a dime'

By Modern Healthcare  |  January 30, 2016

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.

Rocky Medicaid privatization rollout looms as political issue in Iowa

Rocky Medicaid privatization rollout looms as political issue in Iowa

By Harris Meyer  |  January 26, 2016

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.

War on cancer, take two

War on cancer, take two

By Maria Castellucci and Sabriya Rice  |  January 16, 2016

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.

Big insurer defections signal AHIP's fading clout

Big insurer defections signal AHIP's fading clout

By Bob Herman  |  January 09, 2016

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.

CMS in hot seat over exchange rules

CMS in hot seat over exchange rules

By Bob Herman  |  January 02, 2016

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.

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