Politics and Policy

The industry is awaiting the Supreme Court’s ruling on Universal Health Services v. Escobar. This case concerns the viability of the “implied certification” theory of legal falsity under the False Claims Act.

Creating a national data policy framework for empowered consumer choices.

MACRA, which will further the shift to value-based reimbursement, has industry insiders grappling with the complexities, particularly those related to reporting guidelines for providers.

An expansion of the ACA requires health plans to cover a new preventive service: Regular nutritional counseling for millions of overweight Americans with other health risks.

A new study examines payer payment shifts for opioids.

Colorado could have the first statewide universal healthcare system in the country if proposed legislation passes in November. Will it happen? Experts weigh in.

Insight from Paul Markovich, CEO, Blue Shield of California

Doug Chaet, senior vice president, Provider Networks and Value-Based Solutions at Independence Blue Cross, shares five strategies that can help providers succeed in value-based reimbursement models.

Democratic presidential candidate Hillary Clinton vows to provide more affordable, cost effective, accessible, and higher quality healthcare and insurance coverage. Here’s a closer look at seven key ways Clinton would change the healthcare system if elected president.

Drug coupons sound good on paper for both manufacturers who sell more products and for patients who pay less for a high-priced new product. But payers and pharmacy benefits managers are not impressed.

A look at how Trump's specific plans for healthcare could impact the industry.

Though technology companies are continuing to innovate in the wearable field, healthcare organizations are slow to adapt.

A look at how each GOP candidate’s specific plans for healthcare could impact the industry.

New regulations will check the drive to narrow networks, just as the business case for forming them grows more compelling.

Democratic presidential candidates Bernie Sanders and Hillary Clinton both vow to make healthcare more affordable, accessible, and higher quality. Here’s a closer look at two of the ways Sanders proposes to do this.

After suffering significant losses on the health insurance exchanges in 2015, insurance giants UnitedHealth Group and Aetna announced they may leave the exchanges next year.

A glimpse into the present and future of healthcare industry mergers and acquisitions

IMS Health expert predicts future drug spending trends and ways to curb rising costs at the AMCP 2016 conference.

Industry watchers weigh in on UnitedHealth Group’s announcement that it will exit all but a “handful” of state Affordable Care Act (ACA) exchanges.

Republican presidential candidate Donald Trump recently unveiled his 7-point healthcare plan. Find out more.

At the AMCP16 conference, Managed Healthcare Executive invited some of the nation’s leading pharmacy and managed care experts to join us to discuss some of the most critical managed care pharmacy challenges facing the industry.

Covered California adopts significant new changes to its contracts with health insurers as part of an aim to take health care reform to the next level.

Comprehensive Primary Care Plus (CPC+) advanced primary care medical home model aims to strengthen primary care through a regionally-based multipayer payment reform and care delivery transformation.

A new study explores the tangible effects of the ACA and the study author weighs in on the implications for managed care.

Experts says UnitedHealthcare’s new boutique-style health plan is designed to drive innovation in primary care.