Healthcare Reform Blog

Bill MelvilleContributor: Bill Melville
Topics: Connect for Health Colorado, Access Health CT, Kynect, Covered California, Kaiser Permanente, Blue Shield of California, Florida Blue, Blue Cross and Blue Shield of Texas, Humana, CVS Pharmacy

Increasingly consumers go online for holiday shopping, skipping brick-and-mortar stores and shopping malls. During health exchange open enrollment, health insurers and some state-based exchanges are trending in the opposite direction, increasingly testing retail stores as an enrollment alternative.

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Posted on: 12/15/2014 1:57:36 PM

Bill MelvilleContributor: Bill Melville
Topics: Meritus, Health Choice Arizona, University of Arizona Health Plans, Health Net of Arizona, Connect for Health, Colorado HealthOp, Kaiser Permanente, Humana, Mountain Health Cooperative

The news that some exchange carriers will offer lower premiums in 2015 was a surprise in many markets. But the biggest surprise could await exchange customers who stick with their existing exchange plan without shopping around.
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Posted on: 11/24/2014 12:58:53 PM

April Wortham CollinsContributor: April Wortham Collins
Topics: Affordable Care Act, U.S. Supreme Court, health insurance exchange, insurance tax credits, King vs. Burwell

As health insurance exchange enrollment enters Round Two, a cloud of uncertainty is once again forming over the Affordable Care Act. Earlier this month, the U.S. Supreme Court agreed to hear King vs. Burwell, the latest in a string of legal challenges aimed at the controversial law.
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Posted on: 11/18/2014 3:12:59 PM

Merk CherryContributor: Mark Cherry
Topics: Highmark, Blue plans, M&A, BCBS of Minnesota, Florida Blue

Opponents of Obamacare were delivered fresh fodder when Florida Blue announced plans to raise 2015 exchange premiums by 17.6 percent. But instead of being a direct result of the Affordable Care Act, the Blue plan’s increase may have been caused by one of several efforts by the state legislature to undermine the law. Read more.
Posted on: 11/14/2014 5:04:55 PM | with 1 comments

Chris SilvaContributor: Chris Silva
Topics: Centers for Medicare. Medicaid Services, America’s Health Insurance Plans

As the Medicare ACO program enters its fourth year and Part D celebrates its ninth year, the Centers for Medicare & Medicaid Services is investigating ways to marry the two programs to bring coordinated care and the concept of shared savings to Medicare drug benefits. Read more.
Posted on: 11/14/2014 12:04:13 PM

Jenny Kerr

Contributor: Jenny Kerr
Topic: Anthem Blue Cross, Kaiser Permanente, CalPERS, Arizona Health Network, Dignity Health, Abrazo Health, MemorialCare

Maybe it’s a matter of scale. Accountable care organizations in many markets are looking to grow, in some cases expanding to include multiple unaffiliated hospitals and health systems. The question is whether an ACO can be too big and whether competitors in every other aspect except an ACO agreement can effectively coordinate care?

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Posted on: 11/6/2014 9:47:46 AM

April Wortham CollinsContributor: April Wortham Collins
Topics: Health information technology, electronic health records, Office of the National Coordinator for Health Information Technology, HITECH Act, meaningful use, interoperability

Accountable care organizations in Texas were responsible for a large cut of the dollars saved by the Medicare Shared Savings Program thus far. Not all Texas ACOs saved money, but the ones that did indicate that accountable care could have staying power in unexpected places.
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Posted on: 10/30/2014 2:53:17 PM

Chris LewisContributor: Chris Lewis
Topics: Covered California, American Cancer Society Cancer Action Network, Fingertip Formulary, Decision Resources Group

When Covered California first opened for business in 2014, comparing qualified health plans by the drugs they cover was an exercise in frustration.

As outlined in my reform blog a year ago, the public insurance exchange site did not provide readily available formulary information. Some health plans posted the exchange formularies on their websites, but they were difficult to distinguish from other plan drug lists, and the lack of standardization made the lists difficult to navigate and compare.

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Posted on: 10/16/2014 4:12:29 PM

Courtney SnellContributer: Courtney Snell
Topics: ACOs, Pioneer ACOs, Medicare

In the courtroom of public opinion, it’s been a rough couple of weeks for the Centers for Medicare & Medicaid Services and its ACO model. On the coattails of the Medicare Shared Savings Program results came the similarly mixed and disparate performance of the Pioneer ACOs, introducing more questions about the long-term durability of a model that has now lost close to half of its participants. Right now, there is little evidence as to whether Pioneer ACOs are truly pioneering the way healthcare is being delivered and reimbursed. Read more.
Posted on: 10/15/2014 10:14:14 AM

Contributer: Laura Beerman
Topics: ACOs, Pioneer ACOs, Medicare

And another three bite the dust. Following the nine departures from CMS’s Medicare Pioneer ACO program last summer and Sharp HealthCare’s exit in August, Genesys PHO, Franciscan Alliance and Renaissance Health Network have bid adieu to CMS’s brand of accountable care. Predictions are swirling on the program’s demise. But before your local pundit stands on the corner with a sandwich board crying the “The end is nigh,” it’s worth looking at why the Pioneers left and how more departures might be prevented. Read more.
Posted on: 10/2/2014 11:40:16 AM

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