While nearly all plans have some kind of program aimed at managing high-risk patients, not all of them are able to successfully reduce costs. Effective programs require a "high-touch, labor-intensive model" where care teams meet patients in settings other than the hospital or clinic.
Sanford Health sued the U.S. government to recoup unpaid payments under the ACA's risk-corridor program, but it's looking less and less likely that the feds will ever pay up.
Two Blue Cross and Blue Shield affiliates are the latest insurers to sue the federal government over their losses under the Affordable Care Act's risk-corridor program.
Arizona and Texas officials hope the Trump administration will be more receptive to Medicaid waivers that would fund care for the uninsured, impose work requirements and place a life cap on enrollment.
Big changes are coming to healthcare, and they are likely to make things worse for the very people who put Donald Trump in office.
Not-for-profit co-ops and other small health plans have been the leading critics of risk adjustment. Now, Aetna is right behind them.
Several experts called the House GOP manifesto presented by Speaker Paul Ryan a rehash of old conservative ideas that Republicans have never seriously tried to implement.
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.
House Speaker Paul Ryan and some other conservatives believe that putting the sickest Americans into tax-subsidized, high-risk insurance plans would reduce premiums in the commercial market and stabilize it.
The basic difference between the Republican and Democratic candidates' health coverage policies is the debate over what Europeans call social solidarity. In other words, how much should younger, healthier and wealthier people pay for the care of older, sicker and poorer people?
A new flap among conservatives about Republican presidential candidate Marco Rubio's healthcare plan illustrates why the GOP has never been able to unify behind a comprehensive proposal to replace the Affordable Care Act.
Health policy again took a back seat to taxes and Hillary Clinton in the fourth GOP debate, but Carly Fiorina declared the ACA “crony capitalism at its worst” and suggested replacing it with high-risk insurance pools, while arming healthcare consumers with better information.