Health Care Delivery

The duals demonstration project launched last week in five counties, according to officials from the Department of Health Care Services, which is overseeing the project.

Health insurers often try to influence Washington through quiet persuasion in plush offices. To fight potential government cuts for private Medicare plans, however, they've hit the streets.

Patient access to some of the nation's best-known cancer-care centers could become a flashpoint in the simmering controversy surrounding the narrow networks being constructed by some insurers and healthcare providers.

With 2015 Medicare Advantage payment rates and policy changes pending, some lawmakers and associations are urging the Centers for Medicare & Medicaid Services to stick to the cut it proposed while others are calling for rates not to drop.

As retail clinics plan to have a role in improving health outcomes, they must achieve the 3 components of the triple aim: access, quality, and cost.

Two Republicans dueled over Medicaid this morning, as the Senate's foremost opponent of expansion accused another senator of taking the "easy" route in rolling out a plan that would increase coverage.

Before the next season starts, states will be working with insurance companies to craft new plans and oversee new premium rates based on this year's claims. Most states also plan to tinker with or overhaul their websites.

Nonprofit, member-owned cooperatives aim to create more competition and drive prices down.

The public will learn for the first time this fall exactly how much their doctors are paid by the drug companies and devicemakers whose products they use. But don't expect it to be the end of the inquiry.

Healthcare spending rose at the fastest pace in 10 years last quarter, a development that could foreshadow higher costs for consumers this year.

The triple aim promised by healthcare reform-better quality care, greater patient satisfaction, at a lower cost-will play out procedure by procedure, as physicians find ways to deliver better care and find savings.

Wendell Primus, PhD, the veteran legislative aide for US House Minority Leader Nancy Pelosi, D-California, got right to the point when he asked those gathered for the 63rd Scientific Sessions of the American College of Cardiologists if, so far, the Affordable Care Act (ACA) was helping them, as opposed to their patients.

The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.

With less than a week remaining to sign up for private health insurance under the Patient Protection and Affordable Care Act, more than half of the uninsured don't know that March 31 is the deadline.

New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors.

Use of a patient-centered medical home model to care for those with chronic illness reduced costs and trimmed utilization for high-risk patients, according to a three-year study published today in The American Journal of Managed Care

The American Journal of Accountable Care will be the media sponsor for a seminar set for March 27-28, 2014, at Innisbrook Golf and Spa Resort in Palm Harbor, Fla., sponsored by TripleAim ACO Consulting Group. TripleAim's mission for the event is to share how the 29 ACOs that experienced shared savings of $126 million in 2012 accomplished the task, and to guide newer ACOs to success.

A new tier of coverage should be added to the health law's online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry's trade group said Sunday.

Emergency department usage in Massachusetts rose slightly both during and immediately after implementation of a 2006 state law expanding health care access, a sign that broader availability of insurance may increase use of the ED.

Nebraska legislators spent the past year crafting a conservative version of Obamacare's Medicaid expansion that they hoped would gain support in a pretty red state. But after a failed vote in the state legislature Wednesday, the Medicaid expansion is officially dead in Nebraska this year.

The concept of clinical nuance-among others-is highlighted at the University of Michigan Center for Value-Based Insurance Design's annual Summit.

After the disastrous rollout of the healthcare exchanges last October, Kathleen Sebelius has hit the road to pump up enrollment-and it just might be working.

Bundled payments are a step in the right direction when it comes to moving away from a fee-for-service payment structure. They have been proved to cut costs, and providers are responding by producing significantly better outcomes. naviHealth, a postacute care benefit manager, will test one bundled payment model using 11 hospitals in 5 states.

A US Health and Human Services Department (HHS) proposal aims to ease the concerns of consumers who remain frustrated with the health insurance exchanges (HIEs). The plan includes a variety of new insurance standards that would improve the consumer experience of shopping for a health insurance plan on the state and federal exchanges.

Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some the nation's best cancer hospitals are off-limits.

The ambiguous results of the Pioneer ACO evaluation could undermine the case for experimentation, and deter policy makers from moving forward as urgently as they must in order to improve on the ACO model. But it shouldn't.

The Obama administration issued sweeping new proposed rules late Friday affecting provider networks in insurance exchange plans, consumer access to quality information about plans, selection of plans in the small business exchanges, state rules on enrollment navigators, and reinsurance and medical loss ratios for insurers.

Participants in the federal high-risk pool created in the health law will have another month to find coverage, the Obama administration announced Friday.

The risk corridor program, a controversial provision of the Affordable Care Act (ACA), received $5.5 billion in federal funding on Friday.