Health Care Delivery

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.

The Obama administration is requiring health plans in Obamacare insurance marketplaces to include a more robust offering of care providers in 2015 after some early backlash over limited networks in the health care law's first year.

Friday's session of the National Comprehensive Cancer Network's 19th Annual Conference: Advancing the Standard of Cancer Care, featured a well-attended roundtable, The Affordable Care Act: Where Are We Now? Moderated by Clifford Goodman, PhD, of The Lewin Group, the wide-ranging discussion featured panelists Christian G. Downs, JD, MHA, Association of Community Cancer Centers; Liz Fowler, PhD, JD, Johnson & Johnson; Michael Kolodziej, MD, Aetna; Lee H. Newcomer, MD, MHA, UnitedHealthcare; Mohammed S. Ogaily, MD, Henry Ford Health System; W. Thomas Purcell, MD, MBA, University of Colorado Cancer Center; and John C. Winkelmann, MD, Councillor, American Society of Hematology, Oncology Hematology Care, Inc.

The Sustainable Growth Formula (SGR) Repeal and Medicare Provider Payment Modernization Act has been framed as a bipartisan solution to establishing a permanent doc fix. The only problem, it seems, is how Congress will pay for the SGR's elimination.

The White House has decided to reverse roughly $10 billion in cuts to the cost-sharing subsidies that were part of the Patient Protection and Affordable Care Act. That program was originally expected to be slashed by 7.3 % in fiscal 2015 and beyond as part of the sequester cuts.

Criminals are stealing patient records to commit medical identity theft. And the Affordable Care Act (ACA) has made the situation worse, according to a new report from privacy and information security research firm Ponemon Institute.

Health insurance companies across the country remain wary of setting their health plan prices for the 2015 insurance exchanges due to a lack of data needed to make evidence-based decisions.