Health Management

Misreporting of data to the Centers for Medicare and Medicaid Services exposes MCOs to civil litigation and administrative penalties.

The number of deaths from prescription pain relievers dropped 5% in 2012, and new tools are helping in the fight against opioid abuse.

Research has been given a shot in the arm by Apple Corp, which recently expanded the use of ResearchKit to include clinical trials.

An ongoing challenge particular to plans serving duals is a gap between the plans’ reimbursement rates and the health status of the populations they serve.

A new survey from KPMG of 270 healthcare professionals found only 10% are using advanced tools for data collection with analytics and predictive capabilities.

Blue Cross and Blue Shield will launch a health insurance exchange this summer that will support employers’ efforts to help retirees transition from group health benefits to individual Medicare coverage that starts Jan. 1, 2016.

Shifting from fee-for-service to value-based pay depends heavily on five factors.

Data, quality, specialty drug costs and social determinants of health are the pain points that are keeping executives at nonprofit safety net health plans up at night.

People in states that expanded Medicaid under the Affordable Care Act are far more likely to be newly identified with diabetes than in non-expansion states, according to a study published online in Diabetes Care.

As the Medicare program and the healthcare industry at large begins the transition from fee-for-service to value-based reimbursement models, health plans are responding by ramping up collaboration with providers to improve health outcomes, especially for medically-complex Medicare members.

Controversy surrounds the 340B Drug Discount Program, and many industry leaders agree that the healthcare law plays a large part.

A significant and growing performance gap exists between dual eligible and non-dual eligible members that cannot be attributed to a health plan's quality of service, a new study by Inovalon has found.

After the first year of Medicaid expansion under the Affordable Care Act (ACA), some healthcare providers and plans on the front lines are confronting operational-as well as political-challenges.

After several years of uneven progress, the pace of healthcare payment reform shifted into high gear in January when the U.S Department of Health and Human Services (HHS) announced plans to tie 30% of traditional, or fee-for-service, Medicare payments to quality or value alternative payment models by the end of 2016, and 50% by the end of 2018.

The overwhelming majority of state health insurance marketplace plans are not providing required coverage for smoking cessation, according to a new report from the American Lung Association.

Blue Cross Blue Shield of Michigan's program lowered costs and improved patient outcomes.

Blue Cross Blue Shield of Massachusetts has taken big steps to curb the growing opioid addiction problem.

Provisions of the Affordable Care Act will cost $142 billion less over the 2016–2025 period than originally estimated by government agencies, due to slower premium growth and changes in enrollment sources.

A new, “next generation” accountable care organization model that encourages greater coordination between providers and beneficiaries has been launched by the U.S. Department of Health and Human Services.

The Patient Centered Outcomes Research Institute has awarded Kaiser Permanente $14.4 million to compare strategies for active surveillance of current and former smokers to scan for potentially cancerous small growths in the lungs, including more versus less intensive strategies.

Optima Health, which has seen a 500% increase in individual members since 2013, is using technology processes and platforms to monitor and automate the customer experience.

Making sure its members get the right care at the right place and at the right time drove Independence Blue Cross to launch a two-year pilot program last fall with consumer engagement firm Accolade.

Spurred on by the Affordable Care Act, retailers, health plans and providers are staking strong retail positions that are increasing coverage opportunities and access to care.

A low-fat plant-based vegan diet may help obese children lower their risk of heart disease, finds a new study from Cleveland Clinic.

The percentage of employers and plans offering wellness incentives is steadily rising, and program designs are becoming more diverse.