Mary K. Caffrey

Florida's Republican Governor, Rick Scott, tried and failed to expand Medicaid in 2013. Now, a coalition of hospital, business, and community leaders are advocating for private option-style expansion. CMS will have to decide how far it is willing to bend before President Obama leaves office.

Fresh off re-election, Governor Robert Bentley moved this week to name 6 groups to coordinate managed care in Medicaid, as part of a cost-saving strategy he launched in 2012. But the bigger news has been his reversal on expanding the program; as in other Southern states, hospitals have been pressing for the change to solve fiscal problems.

The employer and individual mandates, not Medicaid expansion and state-run exchanges, are what raised the ire of Republicans who gave opinions on the ACA in the most recent Kaiser poll.

MD Anderson and United Healthcare bring experiments with bundled payment models in cancer care to a new area: head and neck cancers.

An attorney for the patient said this is the first lawsuit that alleges actual harm over inadequate networks, not just lack of access. California has had its share of growing pains through ACA expansion and its simultaneous expansion of managed care in its Medicaid program.

After a quieter open enrollment period, HHS officials give a final call for current customers to make changes to existing plans.

As the ACO and Emerging Healthcare Delivery Coalition gather in Miami, results are coming in, and it's time to figure out just what to measure.

Iowa quietly and successfully implemented a unique form of Medicaid expansion and revamped mental health services in 2014. But will budget problems unravel all the good news next year?

The rule being published tomorrow not only grants same-sex spouses the right to act as medical decision-makers, but it also requires Medicare and Medicaid providers to inform patients of these rights.

Blue Shield of California seeks regulatory approval to buy Care1st, which would give the larger insurer a rapidly growing Medicaid plan. Commercial carriers are expected to eye Medicaid plans as a source of growth, especially in states that have approved expansion.

Overuse of scans, transfusions, and the length of time on anticoagulants received attention in the latest round of recommendations presented Monday, as part of the initiative across medicine to improve patient care with an eye toward controlling costs.

Representatives from industry and the FDA share perspectives on the state of regulation for therapeutics and diagnostics at the 56th annual meeting of the American Society of Hematology, being held in San Francisco.

The Sunshine State seeks to hold down costs with managed care for its Medicaid population and seniors, but it's meeting resistance.

With the share of Medicaid beneficiaries enrolled in managed care past the halfway mark, a new online tool from the Kaiser Family Foundation will help policymakers and researchers track its status in 39 states.

Rules issued today will help CMS keep fraudulent providers and suppliers away from Medicare, following a series of crackdowns in "hot spots" around the country.

President Obama is scheduled to visit NIH today to highlight recent results on a potential Ebola vaccine, developed with GlaxoSmithKline. He is expected to call on Congress to pass a $6.2 billion package to combat the current crisis and prevent future outbreaks.

On World AIDS Day, advocates mark "the beginning of the end" of the pandemic. In the United States, 2014 has been marked by battles between patient advocacy groups and some payers over the price of generic HIV drugs on exchanges under the Affordable Care Act.

Authors in the New England Journal of Medicine discuss the prospects and pitfalls of implementing a new CMS fee for physicians who coordinate care for Medicare patients with multiple chronic conditions.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, held its most recent WebEx session this week. Participants discussed new strategies and technologies that both employers and healthcare organizations can use to get patients to take ownership over their own care.

Amid last week's news that CMS had miscalculated the number of enrollees under the Affordable Care Act was a quieter announcement that the agency had appointed a chief data office to improve transparency, among other tasks.

The disclosure that a calculation error caused the Obama administration to add an extra 400,000 people to ACA enrollment figures for months puts a dent in the 2015 open enrollment, in part because it fits a narrative of a lack of transparency for reporters who cover the administration.

A new study shows only a small share of patients with private insurance who were newly diagnosed with diabetes in 2011-2012 enrolled in self-management training, raising questions about how well managed care could address both long-term health and cost control for this important group. These patients are a target for special attention under the ACA.

Results presented today at the American College of Rheumatology in Boston show that a 12-biomarker test did a better job of predicting radiographic progression in patients with RA. The study demonstrates how biomarkers are becoming important in managed care outside of cancer treatment.

Thursday is the Great American Smokeout, an event founded on this date in California in 1976. This year, the event comes amid the 50th anniversary celebration of the report to the US Surgeon General that started public health efforts to curb tobacco use.

After last year's disastrous start, the first day of open enrollment in year 2 of the Affordable Care Act had fewer hiccups. HHS Secretary Sylvia Mathew Burwell was reporting success from this weekend.