Health Plan Business

From Health Plan Week - Health insurers are on the defensive over the way some provider networks for public exchanges are designed, leading to criticism that consumers buying coverage on the new marketplaces don’t have access to out-of-network care. Read more

From Health Plan Week - FDA’s December 2013 approval of hepatitis C drug Sovaldi (sofosbuvir) has rattled health insurers, PBMs and state Medicaid programs, causing “near panic” with some plans because of the drug’s expense, its potential demographic reach and the timing of its market entry. Read more

Health Plan Business Blog

By Jill Brown - March 26, 2014
Most accountable care organizations (ACOs) form as local hospitals, physicians, care coordinators and other community providers decide to come together to supply higher-quality, more coordinated care to patients. But one of the newest members of CMS’s Medicare Shared Savings Program (MSSP) is more...
By Patrick Connole - March 18, 2014
Health plans are likely going to keep pushing their marketing efforts well past the March 31 deadline for open enrollment in order to get as many lives into the exchanges as possible and to cultivate people who experience “qualifying events” throughout the year. These events can include change of...
By Jill Brown - March 4, 2014
Is the patient-centered medical home (PCMH) model unable to achieve meaningful improvements in quality measures and reductions in total costs? Or is a RAND Corp. study that seemed to suggest those findings outdated and flawed? That is the controversy that erupted after the Journal of the American...

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