Industry Analysis

New guidelines from HHS reveal a fee equal to 3.5% of premiums for plans participating in federal exchanges.

The National Governors Assn. talks Medicaid with President Obama during fiscial policy meetings.

Unnecessary diagnostic tests are harmful to patients and costly for health plans.

The specialty pharmacy market is currently fragmented with extreme variation in knowledge and education, patient care management, service, and outcomes.

Last month, the National Quality Forum (NQF) endorsed 10 behavioral-health quality measures

Experts are paying closer attention to medication reconciliation as a means to curb cost, but providers are finding the implementation isn't always easy.

More than $8 billion has been saved this year as a result of the American Medical Association's (AMA) Heal the Claims Process campaign

A study of 1.7 million patients with diabetes indicates that reducing inflammation of the mouth can produce improvement in other health measures.

While most states have policies to evaluate premium increases, the Rate Review Program under the Patient Protection and Affordable Care Act (PPACA) puts a brighter spotlight on states' authority.

Health Choice Arizona has instituted a new scheduling system to help it connect patients with appropriate community health resources on a timely basis. It wanted to find a way to help those members with the lowest incidence of preventive service completion quickly schedule their appointments.

One of the largest pharmacy benefits managers in the U.S. is about to get bigger. Health Net Inc. says it will sell its Medicare prescription-drug plan (PDP) business to CVS Caremark Corp. (CVS) for about $160 million in cash.

Managing consulting firm Peppers & Rogers Group released the results of its Trustability in Health Care study, which showed that consumers are willing to pay more for services from trustworthy health insurers. Respondents said they would be willing to pay on average $30 a month more to do business with a health insurer they trust, with some willing to pay up to $100 a month total

A slowing of the growth in use of healthcare goods and services contributed to a second year of slow health spending growth in 2010, according to federal analysts. A number of factors combined to make 2009 and 2010 the two slowest growth rates in 51-year history of National Health Expenditure Accounts estimates.

Providers and payers appear to be moving steadily toward an accountable-care model of healthcare delivery, and competitive markets influence the development.

Advocates for community-based plans are driving the message that they can and do provide value.

ACOs will be expected to have accreditation as a minimum standard.

While the politicians campaign, the federal government will continue to roll out the programs created by the Patient Protection and Affordable Care Act

Most top-quality health plans in the U.S. are offered by nonprofit organizations, says Bruce McPherson, president and CEO of Alliance for Advancing Nonprofit Health Care. He bases that claim on 2011 rankings recently released by the National Committee for Quality Assurance (NCQA)

Cancer drives healthcare costs - to the tune of $124 billion on cancer drugs in 2010 alone - according to Medco, a pharmacy benefit manager. But nutritional counseling of cancer patients is often ignored, even though by some estimates most cancer patients will develop clinical malnutrition.

Nearly a third of the Medicare population is obese, which leads to more serious health problems that are expensive to treat. The Centers for Medicare & Medicaid Services (CMS) have decided to cover obesity screening and counseling as a preventative measure, but are primary care physicians equipped to provide such services?

Prime Therapeutics (Prime) will administer pharmacy benefits for Blue Cross and Blue Shield of North Carolina (BCBSNC) commercial customers staring in April next year. The companies say the move will result in lower pharmacy costs for BCBSNC customers and more flexibility regarding services and programs.

The Archon Genomics X PRIZE presented by Medco will measure teams on accuracy, cost, speed and completeness of genome sequencing. The goal is to push the industry to develop, more accurate, faster and more cost effective sequencing technologies.

Two University of Michigan (UM) developed healthcare initiatives were recommended to the U.S. Secretary of Health and Human Services in an Institute of Medicine report about the future of the nation’s healthcare.

Medicare Advantage plans may have a difficult time attaining four- and five-star ratings under the Centers for Medicare & Medicaid Services’ (CMS) Five-Star Quality Rating System if they don’t keep up with the system’s changes.

The Obama administration has moved one step closer to defining the healthcare services insurers will have to offer in exchanges.