Aetna and Humana fought back against the U.S. Justice Department's challenge to their proposed $37 billion merger, saying the feds' arguments ignore the fluid nature of Medicare Advantage markets.
Not-for-profit co-ops and other small health plans have been the leading critics of risk adjustment. Now, Aetna is right behind them.
The five-star system as launched underdelivers for consumers and imperils hospitals' journey to improve value for patients.
The federal government will expand a new Medicare Advantage program to three states in 2018 and allow interested insurers to offer expanded benefits to two new types of chronically ill members.
A new requirement for hospitals to notify Medicare patients when they are receiving observation care but have not been admitted will cost the industry $23 million annually, according to the CMS.
Co-founded in 2015 by former venture capitalist Travis Messina, Nashville-based Contessa Health provides medical and surgical acute-care services to patients in their homes at a bundled rate.
Even if the feds bury Anthem's acquisition of Cigna and Aetna's Humana deal, the big five health insurers are likely to forge new transactions to scale up and improve their position at the bargaining table with consolidating hospitals and systems.
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.
Providence Health & Services CEO Dr. Rod Hochman discusses his aggressive population health management strategy for his 34-hospital system and Providence's proposed merger with St. Joseph Health System, which would have major implications for the competitive landscape in the Los Angeles basin.
Federal and state insurance regulators are mulling the fate of two pending health insurance mergers, and many large employers won't be disappointed if officials torpedo the deals.
Evolent's technology and consulting platform can help identify high-risk patients by analyzing data from multiple sources and then create physician-driven care-management plans.
A new bill making the rounds on Capitol Hill has a hospital-centric theme. But private Medicare Advantage insurers with bad quality ratings would also benefit from one surreptitious provision.