Health Plan Business

From The AIS Report on Blue Cross and Blue Shield Plans - Blue Cross and Blue Shield of Texas (BCBSTX), a division of Health Care Service Corp., struck a deal with the nation’s largest physician group, the Texas Medical Association (TMA), in a new incarnation of the accountable care organization (ACO) model, the two groups said on Feb. 5. The partnership, which incorporates 48,000 TMA physicians and more than 5 million BCBSTX members, is significant in that it represents a break in the tradition of insurers partnering with ACOs led by sizeable health systems, instead bringing tech-challenged independent doctors into the fold of value-based care. Read more

From The AIS Report on Blue Cross and Blue Shield Plans - Programs that reward providers for effectively treating the chronically ill while keeping healthy members out of the hospital are nothing new. But the financial rewards for providers are becoming more meaningful as the industry inches away from the fee-for-service model. Since 2011, Harrisburg, Pa.-based Capital BlueCross says accountable care arrangements with physician offices have led to healthier members, lower medical costs and improved quality of care. “I think it is imperative… Read more

Health Plan Business Blog

By Jill Brown - March 27, 2015
Many accountable care organizations (ACOs) focus on the low-hanging fruit first, tackling areas like readmissions, post-acute care and out-of-network referrals. But ACOs that hold contracts with Medicare or commercial payers may want to take a look at the Medicaid program for strategies for...
By Jill Brown - March 4, 2015
While some insurers add centers of excellence or dental services to their standard benefits package, one Pacific Northwest health plan and benefits manager became the first in the nation to include among its standard benefits a new kind of protection against misuse of protected health information...
By Patrick Connole - February 19, 2015
The Supreme Court by the end of June is expected to tell the world if federal health insurance exchanges under the Affordable Care Act (ACA) can include subsidy payments to enrollees, deciphering whether a seeming oversight in the law’s language is enough to scuttle coverage for potentially...

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