More states have started questioning Aetna's prior-authorization practices in the wake of a former Aetna medical director's admission that he never reviewed patient medical records when deciding whether to pay for treatment.
The CMS expects millions of young, healthy and high-income people will choose to lose insurance as a result of Congress' repeal of the penalty for not being covered.
Only one-third of hospital leaders surveyed said their facility was highly capable of interoperability even though 98% said it was an important asset in the move to value-based payment in the next three years.
A former Aetna medical director admitted he didn't review patient medical records when making treatment authorization decisions. That's put a microscope on insurers' processes and could thwart Aetna's proposed merger with pharmacy giant CVS Health.
New York-based insurer Oscar Health's individual membership surged to roughly 252,500 this year from about 100,000 in 2017. A narrow provider network with a big name health system at the center is the cornerstone of its strategy.
Cathy Eddy, founder and president of the Health Plan Alliance, is retiring at the end of April. Joe Lastinger, a former Baylor Scott & White Health executive, will take over as president effective immediately.
Cigna Corp. CEO David Cordani said there's opportunity for the insurer in the Amazon-JPMorgan Chase-Berkshire Hathaway venture. Meanwhile, the insurer reported that customer growth and higher premiums and fees helped boost its 2017 revenue.
After losing its contract with the state of New Mexico, Molina Healthcare is seeking an injunction against the New Mexico Human Services Department and the agency's secretary.
In the midst of a push to combine with CVS Health, Aetna posted lower revenue in its fourth-quarter and full-year 2017 results as decreased premiums and fewer members in its Affordable Care Act individual and small group plans held down the top line.
Direct contracting, in which self-funded businesses eschew insurance companies to partner directly with a healthcare provider, can give the employer more control over the employee health benefit design.
Concerned about soaring healthcare costs, Idaho revealed a plan that will allow insurance companies to sell cheaper policies that ditch key provisions of the Affordable Care Act. It's believed to be the first state to take formal steps without prior federal approval.
Higher prices—not the use of more healthcare services—drove increased healthcare spending in 2016 among patients covered by employer-sponsored plans.