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Some states iffy on extending 'duals' demo

By Virgil Dickson  |  September 04, 2015

The Obama administration says it needs more time than expected to evaluate a large-scale test that aims to better manage benefits and care for low-income and disabled Americans. The 12 states participating in the initiative seem willing to stick with it, although the two biggest ones have...

What Medicare's value-based insurance test could mean for commercial plans

By Bob Herman  |  September 03, 2015

Supporters hope a new Medicare Advantage experiment offering lower out-of-pocket costs for high-value services and providers will become a template for health plans with sizable cost-sharing, which have become the standard offering from employers and insurers.

Medicare Advantage plans to test value-based insurance design

By Bob Herman  |  September 01, 2015

The CMS Innovation Center unveiled a new demonstration program Tuesday that will allow Medicare Advantage insurers to encourage the use of clinically valuable services by lowering out-of-pocket costs for enrollees.

Whistle-blower in $320 million SCAN case not entitled to cash

By Lisa Schencker  |  August 31, 2015

The whistle-blower whose case led to a whopping $320 million settlement between the government and SCAN Health Plan in 2012 is not entitled to any of that cash, a federal judge has ruled. Some say the decision could lead to fewer whistle-blowers bringing cases against Medicare Advantage plans.

Some Advantage plans lose members

Some Advantage plans lose members

By Bob Herman  |  August 29, 2015

Medicare Advantage has been held up as a source of solid growth for health insurers. Humana's reach and expertise in the market attracted Aetna's $37 billion buyout bid. But not all Advantage plans are benefiting from the enrollment wave.

Data Points for Aug. 31, 2015

Data Points for Aug. 31, 2015

By Modern Healthcare  |  August 29, 2015

Data Points for the week of Aug. 31, 2015, covered the following topics: Estimated cost for U.S. military to provide transition-related healthcare to transgender personnel, nursing home care, Medicare Advantage competition and physician diversity.

Closer provider-insurer ties bring new challenges

Closer provider-insurer ties bring new challenges

By Joseph Conn  |  August 15, 2015

Increased collaboration between providers and payers is inevitable, but that doesn't mean the future financial interests of these oft-warring parties will align, say healthcare leaders surveyed in Modern Healthcare's third-quarter CEO Power Panel poll.

Many providers say no to bundled-payment test

By Melanie Evans  |  August 15, 2015

As Medicare prepares to require hundreds of hospitals to take bundled payments for some orthopedic surgeries, about two-thirds of the hospitals, medical groups and other providers mulling whether to join the Obama administration's voluntary bundled-payment program said, “No thanks.”

A suitor turned grudging merger target

By Bob Herman  |  August 15, 2015

Behind the scenes of the months-long Humana acquisition drama, Aetna CEO Mark Bertolini bested Cigna Corp. CEO David Cordani at every turn. Cordani wound up getting very little of what he wanted, including a top job.

Anthem-Cigna merger poses promise and perils

Anthem-Cigna merger poses promise and perils

By Bob Herman  |  July 25, 2015

Anthem's announced $54.2 billion takeover of Cigna Corp. last week is the latest and largest sign of health insurers' lust for scale. But at the heart of the merger momentum is their desire to expand their government business, particularly in the lucrative Medicare Advantage market.

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