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From Blue Shield of California's recently-announced purchase of a Medicaid plan to Partners HealthCare's hard-fought effort to fold more hospitals into its Massachusetts health system, the volume of mergers and acquisitions...
Envisioning a public health threat, managed care recently notched up its readiness for an Ebola outbreak in the United States. Valuable lessons emerged from the latest effort, adding to the knowledge gleaned from other epidemics, such...
Unlike a traditional formulary, the value-based formulary emphasizes the clinical effectiveness of a drug rather than cost so that if a drug is very effective but expensive, it might still fall on tier one.
Nearly a year after two medical societies released a national consensus statement on the safe prevention of certain C-sections, broad consensus seems to boil down to this: Steps must be taken to lower C-section rates in the U.S., and...
The industry is challenged by a number of issues in 2015 including cost control, technology threats, and the emerging consumer market.
espite the fact that approximately 2.74 million patients used anti-obesity drugs in 2011, according to information services company IMS Health, the majority of health plans are following the lead of the Centers for Medicare and...
Two goals of the Affordable Care Act (ACA) are to provide more Americans with health insurance and lower the overall cost of healthcare. Managed Healthcare Executive recently asked four stakeholders to share their thoughts on what the...
In many ways, autism is a nightmare condition for health plans. Its prevalence appears to be skyrocketing, it typically requires long-term treatment, diagnoses are being made at younger and younger ages, there is a plethora of...
It is with great excitement that we unveil our network-wide redesign. Please read further to learn more about a few of our new features, and browse around to explore the new site!
As of January 1, 2015, the U.S. Centers for Medicare and Medicaid will only be awarding payments to MA plans that receive 4 stars or higher.

INDUSTRY ANALYSIS
Indiana is 28th state to expand ...

Indiana will become the 28th state, plus the District of Columbia, to expand Medicaid under the Affordable Care Act (ACA).

CMS Administrator Marilyn Tavenner ...
Two GOP-led states receive approval ...
More enrollees eligible for tax ...

PHARMACY BEST PRACTICES
Limiting drug insurance not the ...

Limiting drug insurance is not an effective strategy for reducing the rising healthcare costs in the U.S., according to ...

Anthem strikes deal with Gilead ...
The rising cost of generic drugs
Specialty drugs and the role of ...

ACCOUNTABLE CARE
HHS announces historic changes to ...

Measurable goals and a timeline to move the Medicare program towards a value versus volume reimbursement model is being ...

Industry expects to recoup ...
2015 for Health Insurers: What’s Ahead?
[BLOG]: Hepatitis C market ...

POLICY
HHS promotes open enrollment with ...

With the launch of two open enrollment cycles behind it, the U.S. Department of Health and Human Services has turned its ...

House passes two bills affecting ...
Fate of Obamacare uncertain
Supreme Court will hear ACA tax ...

LEGAL
ICD-10's impact on reimbursement

While ICD-10 implementation has been delayed until October 2015, providers must appreciate that many current managed care ...

Federal subsidies questioned
Managing obesity from a legal ...
Be aware of data mining risks

FOR YOUR BENEFIT
Three game changers threaten the ...

In the healthcare industry, most executives have placed huge caveats on their organization's plans for 2015. Looming this ...

Gain narrow network buy-in
Accountable care works
2014 was a year of growth and change ...

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