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Harvard Pilgrim CEO talks about narrrow networks and reform

Harvard Pilgrim CEO talks about narrrow networks and reform

By Modern Healthcare  |  November 22, 2014

Eric Schultz, CEO of Wellesley, Mass.-based Harvard Pilgrim Health Care, discusses his organization's experience with the Obamacare insurance exchanges, narrow provider networks, re-entering the Medicare Advantage program, and his views on the expansion of Partners HealthCare in Massachusetts.

Score another point for Highmark with senior health plan

By Lisa Schencker  |  October 31, 2014

Insurer Highmark has won the latest round in its battle with healthcare giant UPMC. A Pennsylvania judge Thursday ruled that a Highmark health plan for seniors does not violate the terms of a previous agreement between the two entities, despite such allegations by state officials.

Coming Medicaid plan rules will set new access standards

By Virgil Dickson  |  October 28, 2014

CMS officials say they're on track for a January 2015 release of sweeping new Medicaid managed-care regulations intended to ensure that beneficiaries get timely access to care and better integration of services.

Insurance execs vow to fight further cuts to Medicare Advantage

Insurance execs vow to fight further cuts to Medicare Advantage

By Paul Demko  |  October 08, 2014

Health insurers are justified in raising alarms about the harmful effects of Medicare Advantage program cuts, executives with two of the country's largest health plans said Wednesday at a Washington forum. They promised to fight further reductions in spending on the popular coverage program for...

How healthcare's Washington lobbying machine gets the job done

How healthcare's Washington lobbying machine gets the job done

By Paul Demko  |  October 04, 2014

Providers, insurers, drug and device manufacturers, and the major trade associations are among the largest funders of the inside-the-Beltway influence industry. This year, they're on pace to spend nearly $500 million seeking to advance policies or avoid setbacks on issues crucial to their interests.

Fewer Medicare Rx plans offered for 2015: Avalere study

By Paul Demko  |  September 22, 2014

The number of prescription drug plans available to seniors will drop by roughly 14% for 2015, according to an analysis of Medicare filings by Avalere Health. The number of Medicare Part D plans nationwide will decrease from 1,169 this year to 1,001 in 2015.

CMS expects Medicare Advantage 2015 premiums to be flat for most enrollees

By Paul Demko  |  September 18, 2014

The average monthly premium for Medicare Advantage plans in 2015 will be $33.90—an increase of $2.94, or 9.5%, over the current year. But as a result of more individuals seeking out lower-cost plans, the CMS estimates that the average premium hike will actually be $1.30 per month. And the...

MedPAC disputes that half of new Medicare enrollees pick Advantage

MedPAC disputes that half of new Medicare enrollees pick Advantage

By Paul Demko  |  September 15, 2014

Half of new Medicare beneficiaries are opting for private plans over the traditional fee-for-service program. That's a statistic that's been reported by Modern Healthcare and other publications in recent years. Healthcare consultant John Gorman, one of the foremost experts on Medicare Advantage,...

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