Politics and Policy

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.

Nearly four in 10 organizations that offer health insurance through state exchanges also operate a Medicaid managed care plan in the same state, offering an opportunity for continuous coverage for low-income consumers.

Two recent studies show that members who obtain health insurance through state or federal insurance exchanges use more specialty and generic drugs than their counterparts in commercial plans.

The new Republican-controlled Congress takes aim at the Affordable Care Act.

A group of the top U.S. health systems, payers and stakeholders has formed the Health Care Transformation Task Force, a private-sector alliance aimed at accelerating the healthcare industry's transformation to value-based care

Measurable goals and a timeline to move the Medicare program towards a value versus volume reimbursement model is being called a "transformative shift" that could redefine how care should be provided, measured and rewarded.

According to the research firm Gartner, Inc., information technology is subject to a five-phase acceptance cycle: a Technology Trigger, Peak of Inflated Expectations, Trough of Disillusionment, Slope of Enlightenment, and Plateau of Productivity. Even zealous advocates of social media marketing (SMM) admit their craft is currently stuck in the disillusionment phase.

With the launch of two open enrollment cycles behind it, the U.S. Department of Health and Human Services has turned its attention to promoting HealthCare.gov with a growing list of partners.

Unlike a traditional formulary, the value-based formulary emphasizes the clinical effectiveness of a drug rather than cost so that if a drug is very effective but expensive, it might still fall on tier one.

From Blue Shield of California's recently-announced purchase of a Medicaid plan to Partners HealthCare's hard-fought effort to fold more hospitals into its Massachusetts health system, the volume of mergers and acquisitions in the healthcare sector has steadily climbed and now exceeds M & A activities in all other U.S. industries. The surge is being fueled by payers and providers seeking new business opportunities in the post-ACA healthcare market, and 2015 is on track to be another record-breaking year.

Envisioning a public health threat, managed care recently notched up its readiness for an Ebola outbreak in the United States. Valuable lessons emerged from the latest effort, adding to the knowledge gleaned from other epidemics, such as the HIV/AIDS and SARS viruses and the bird flu.

Nearly a year after two medical societies released a national consensus statement on the safe prevention of certain C-sections, broad consensus seems to boil down to this: Steps must be taken to lower C-section rates in the U.S., and strong outreach to ob/gyns is critical for success.

CMS Administrator Marilyn Tavenner, a life-long public health advocate tapped to lead the $820 billion federal agency, will step down from her role at the end of February.

Arkansas and Iowa, two GOP-led states, have received approval for customized options for Medicaid expansion that include cost-sharing provisions for beneficiaries.

The U.S. House of Representatives passed two bills this week affecting employer mandate reforms that are part of the Affordable Care Act (ACA), but one is headed for a veto if it clears the U.S. Senate.

About 87% of all enrollees during the first month of open enrollment on healthcare.gov were eligible for financial assistance, compared to 80% during a similar time frame in 2014.

Texas, which has almost 1 million residents in the coverage gap, has inquired about Medicaid expansion, while Arizona faces a renewed challenge to its existing expansion program.

The Centers for Medicare and Medicaid Services announced that it has selected Accenture Federal Services for a five-year, $563 million contract to continue Accenture’s work on the federally facilitated marketplace in support of healthcare.gov.

Eighty-nine new accountable care organizations will join the Medicare Shared Savings program in 2015, bringing the total number of participants to 405.

The Affordable Care Act has ushered in a new era of convergence among healthcare payers and providers.

More than half of all Medicaid beneficiaries nationwide were enrolled in a managed care organization as of September 2014, according to a new analysis by the Kaiser Family Fund.

The number of states deciding to pursue some form of Medicaid expansion continues to grow, with Alabama, Alaska, Florida, Tennessee and Wyoming moving forward or indicating intent to pursue an alternative plan.

Customers at 7-11 stores who use a bill-paying system will receive information promoting the Affordable Care Act’s open enrollment period on their printed receipts, allowing HHS to reach financially underserved consumers.

Almost 2.5 million consumers signed up for health insurance through December 15 as part of open enrollment, and 48% were new consumers.

Looking to capitalize on California’s decision to expand Medicaid, Blue Shield of California has purchased Care 1st of Monterey Park, which will add 473,000 Medicaid managed-care members to its rolls.