Business Strategy

If you like your reform law, you won't be able to keep it

Confused members might opt for the worst choice under ACA

The 834 transfer is still on the punch list

Advanced analytic solutions are being used to detect improper payments in pharmacy claims.

Some fixes have been created for insurers selling through healthcare.gov but not many

Even under innovative payment models, RBRVS is here to stay

Consider shifting to condition episodes and linking member benefits

New utilization management opportunities will increasingly include cardiology and diagnosis of sleep disorders.

Redesign your industry interactions

PBGH program gives employees no-cost joint replacement and free travel to top hospitals

New tests and drug treatments on the horizon.

With healthcare reform moving ahead, payers have their hands full.

Remote monitoring helps plans keep tabs on member progress

Commonwealth Fund: Low-income families have advantages in top performing states

One of many things that will cause rates to increase between 2013 and 2014.

Managed care appears to fare well under PPACA

Convenient sound bites do not take the place of true intelligence.

New network designs drive quality through data sharing

A global Accenture study shows patients want access to EMRs so they can get more involved in their care

Stakeholders weigh the pros and cons of convenient care clinics found in drug stores and grocery outlets

A key initiative for Seaside Health Plan is California Children’s Services demo

Personalizing statements is good customer service.

Prevalence of chronic pain can add up to higher costs in mental-health and medical claims

HIPAA rules expect health organizations to protect and secure a wide variety of personal data

Workers have their own ideas on who's getting the best deal in health coverage