Health Care Delivery

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.

States designing and testing healthcare payment and service delivery models to improve quality of care and lower costs will be receiving more than $665 million in funding from the government, according to HHS Secretary Sylvia M. Burwell.

How do ACOs reach the point of delivering both savings and better care? The recent online session of the ACO and Emerging Healthcare Delivery Coalition, sponsored by The American Journal of Managed Care, covered how ACOs evolve, how that process applies to oncology care, and how managed care can benefit from a better model for mental health delivery.

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.

Tennessee became the latest Republican-led state to gain approval for a Medicaid expansion option when Gov Bill Haslam unveiled the Insure Tennessee plan Monday morning. There are just 20 states left that have not expanded Medicaid.

The 2014 elections are likely to have minor, but noticeable impacts on the future of the Medicaid program, both in terms of federal conversations on entitlement reform and in state approaches to the Medicaid expansion.

As Medicaid enrollment grows under the program's expansion, there are not enough providers to serve the increased amounts of enrollees, according to a new report from the Office of the Inspector General that measured the availability of specific providers in Medicaid managed care networks.

The study published in Health Affairs recommends standardization of benefit plans across states for children, especially those related to developmental abilities.

Highly-paid doctors make more money ordering multiple procedures for individual patients than they earn seeing multiple patients, suggesting payment reform under the Affordable Care Act has yet to be realized.

The federal government may have made strides to improve the health insurance exchanges since last year's open enrollment, but a majority of Americans view shopping for health insurance as just as bad as or worse than doing their taxes.

Republicans in the US Congress plan to renew their attacks on President Barack Obama and his signature healthcare plan on Tuesday when they grill a consultant who said "the stupidity of the American voter" helped ensure the law's passage.

One criticism of the Affordable Care Act is that it imposes a costly, one-size-fits-all standard, drastically increasing premiums by requiring everyone to buy health insurance that covers the same mandated benefits. This is not so.

For 2015, marketplaces' ability to conduct an effective renewal process for current enrollees is constrained by their information technology capacity, the short time period for open enrollment, and limited resources for outreach and consumer assistance.

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.

Dr Kavita Patel, a practicing physician and a policy researcher at the Brookings Institution, writes in her opinion piece that Obamacare has achieved it's purported goals.

The part of HealthCare.gov intended for small businesses opened with reports of only modest technical flaws-but with doubts that it will soon benefit the millions of workers at little companies with inadequate health insurance or none at all.

A small business owner describes his experience with buying health benefit for his employees through the Affordable Care Act plans.

The rule applies to restaurants, retail food establishments, and vending machines with 20 or more locations.

Few employers are planning to eliminate their health benefits in 2015, but they are still looking to make noticeable changes, according to a report from the Employee Benefit Research Institute.

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.

Researchers at Vanderbilt University Medical Center have used electronic health record analysis to uncover hidden drug benefits, according to a study appearing in the Journal of the American Medical Informatics Association.

In March, the Obama administration released guidance extending the renewal of health insurance policies that do not meet the Affordable Care Act's coverage standards through October 1, 2016. At least 9 states that did not adopt the administration's original transitional policy are now allowing renewals of noncompliant policies after January 1, 2014.

Republicans finally filed a lawsuit against President Obama's healthcare reform law, the Affordable Care Act, after approving the suit in July. They are challenging the employer-based coverage aspect of the law, as well as Treasury payments to insurers.

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.