Leading consulting firms and a growing list of niche advisers are competing aggressively to help major insurers use big data to identify high-risk patients and manage their costs.
A provision within the new Medicare physician payment law eliminates the most popular types of Medigap plans and therefore will lead to future Medigap enrollees paying more out of pocket for their medical care.
The Affordable Care Act's exchanges have not been a bust for every health insurer. Florida's Blue Cross and Blue Shield affiliate made a profit of almost a half-billion dollars on the ACA's new individual plans last year.
Over the past two decades, especially in the years since the ACA passed, there has been a gradual movement toward paying board members at national or regional hospital systems, integrated provider-payer organizations and insurers. And some of the payouts are quite substantial.
Health insurer Highmark is suing the federal government to recover money owed under the risk-corridor program for plans sold on the Affordable Care Act's insurance exchanges. Republicans in Congress, calling the program a bailout for insurers, stymied HHS' ability to cover the obligations.
Highmark Health lost $590 million on its health plans sold on the Affordable Care Act exchanges in 2015, joining the ranks of other large multistate companies that covered marketplace patients who desperately needed and used care.
Dr. Patrick Battey has been named CEO of Piedmont Atlanta Hospital after serving as co-CEO with Les Donahue the previous year. He is the first physician to serve as CEO since the hospital opened in 1905.
Cynthia Hundorfean has served as chief administrative officer at the Cleveland Clinic since 2005. She will take over as CEO of Highmark's provider network in February as her predecessor, John Paul, becomes special adviser to Highmark Health CEO David Holmberg.
David Holmberg, president and CEO of Pittsburgh-based not-for-profit Highmark Health, recently spoke with Modern Healthcare about the feud with rival UPMC, the future of the Affordable Care Act exchange business and the value of high-deductible health plans.
Pittsburgh-based UPMC must continue to provide in-network services to members of Highmark's Medicare Advantage plans, the Pennsylvania Supreme Court has ruled.
Will Highmark and UPMC ever bury the hatchet? David Holmberg, CEO of Pittsburgh-based health insurer and integrated delivery system Highmark Health, weighs in on its fierce battle with UPMC for the region's healthcare market.
Pittsburgh-based UPMC will soon get another day in court to challenge a ruling that it must continue to provide in-network services to members of Highmark's Medicare Advantage plans.