Health Reform

As States Update Systems, Build New Ones, IT Vendors Face Challenges, Opportunities

From Inside Health Insurance Exchanges - Millions in federal grant funding and a flurry of requests for proposals (RFPs) ensure that information technology (IT) vendors will have little idle time in 2012. While many states are reluctant to move forward on exchange development until the Supreme Court renders a decision on the constitutionality of the individual mandate requirement, other states are pushing hard to build IT systems that will allow them to develop an insurance exchange by the end of the year and update ancient Medicaid systems. Read more

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2012 Outlook: Medicaid Reforms at State, Federal Level Will Lead to New Opportunities for Plans

From AIS's Health Reform Week - Medicaid managed care plans may prove their usefulness in containing costs in 2012, as states seek out alternative policies and payment/delivery models to cope with a looming Medicaid expansion under the health reform law, not to mention ongoing budget constraints, industry insiders predict. Dan Mendelson, CEO of consulting firm Avalere Health LLC, forecasts that 2012 is going to yield a “very active market” for Medicaid managed care plans and for some… Read more

Outlook 2012: Whatever ACA’s Legal Outcome, ACOs Will Survive in Medicare

From ACO Business News - Medicare’s ACO programs, which are tied to the Affordable Care Act, could find themselves in a vulnerable position in 2012, with both a Supreme Court decision on the reform statute and potential budget cuts looming on the horizon. Read more

On the Health Reform Bookshelf

Financial Impact of Medical Loss Ratio Regulations

Pre-Existing Condition Exclusions

Impact of Health Reform on Benefit Design

Health Reform Blog

ACO Models Are Eyeing the Pediatric Population

By Jennifer Lubell - January 30, 2012

We’ve all read about the quest to cover Medicare populations in accountable care, but as of late, I’ve been seeing more news items about kids being the focus of ACO-type models. Several efforts are under way in the private sector and at the state level to apply this concept to pediatric care. The...

HHS Will Certify Exchanges Next Year….but What Does That Mean, Exactly?

By Steve Davis - January 24, 2012

The White House last week hailed 28 states — led by both Republican and Democratic governors — that “are on their way toward establishing” a health insurance exchange. So far, HHS has issued three rounds of establishment grants, collectively worth up to $729 million. But states might run out of...

Dearth of ACOs

By Jennifer Lubell - January 17, 2012

As the “accountable care boom” strides on in certain parts of the country, no soil is being tilled at all, it seems, in other areas to grow these new models of care. A recent story in ACO Business News highlighted a white paper by Leavitt Partners’ Center for ACO Intelligence, which tracks...

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