Business Strategy

Experts say directly comparing ACO models can be difficult because stakeholders often take different approaches to care management

Terminally ill patients and their families often want to know to everything about the prognosis

Transitions, health management, and business industry updates

Consumer experience is a critical area of investment, with health plans increasing data analytics and virtual customer service

The American Action Forum data breaks down the variation in MA cuts by state-a large percentage of the cuts coming from changes in payment formulas

Final notice from CMS changes the 1.9% pay cut to 0.4% increase, but that's only half the story

Prepare for a significant increase in self-pay liabilities from the “high-deductible“ patient population or risk a reduced level of reimbursement

Mammograms contribute 62% of the cost and the remaining 38% is attributed to follow-on diagnostics.

Employers want defined contribution

CMS is driving down rates for MA plans while taxes and dwindling bonus pay pile on the pain

Value-based designs aren’t just nice add-ons, but rather they represent new business propositions

Industry updates in business and health management

To successfully navigate the structural break in healthcare, payers need to boost investment returns through strategic clarity, resource alignment, and supportive organizations

Hardship exemptions aren't clear enough for consumers to take a chance on special enrollment period

The case will be decided on the burden the ACA contraceptive mandate has on private employer Hobby Lobby

Their care experience isn’t at the level it should be

Add it up: 3 reasons for the delay; 6 assets affected; 6 reasons for the price tag; and one future mind-boggler

While 4.2 million have signed up for private plans, quite a few of them also have a sense of humor

Plans have opportunities to bridge the transition for non-grandfathered plans and PCP payments under ACA

Quality and research initiatives in engagement and the value of investment in population health programs will be a focus in 2014.

While patients may complain about the rising cost of their healthcare, few of them appear willing to do much about it, according to a new survey.

Health management and business updates

These approaches exemplify the path health plans need to take for effective consumer centricity.

Test ICD-10 systems early and often in order to minimize errors during the transition.

Pushback from members has caused regulators to take notice.