Consumers Hit By Higher Out-of-Network Medical Costs
Insurers switch to new way to calculate reimbursement that shifts more of the expenses onto patients.
Panel Sidesteps Controversy On Draft For Comparative Effectiveness Research
The Patient-Centered Outcomes Research Institute (PCORI) — created by the health law to help determine the most effective medical treatments — released its draft priorities and research agenda on Monday, but it did not single out any specific diseases, treatments or procedures to study. Instead, the nongovernmental institute that will oversee billions in research funding […]
A Health Exchange Progress Report, Sort Of …
They’re making progress! Well, at least 28 of them and the District of Columbia are. That was the main talking point from the White House this morning during a press briefing revolving around a report stating that 28 states are “on their way” to establishing new marketplaces, called exchanges, where consumers can begin to shop for health insurance […]
New Group To Set Priorities for Medical Effectiveness Research
Congress is betting more than $3 billion over the next decade that “comparative effectiveness” research can transform medical care by helping determine the best approach to a particular illness.
Feds Face Challenges In Launching U.S. Health Exchange
Technical, political and financial obstacles loom as clock ticks toward 2014 deadline for operations.
HHS Gives States Flexibility On Health Law’s ‘Essential Benefits’
States will be given wide latitude to decide what “essential benefits” insurers must offer in policies offered on new health exchanges come 2014, the Obama administration said Friday in a move that pushes off final federal rules on those benefits until sometime next year.
Blue Shield Of Calif., UCLA Tussle Over Rates
Blue Shield of California, which earlier this year pledged to cap its profits at 2 percent, took public Tuesday a contract dispute with UCLA Medical Center, which saw a nearly 17 percent operating margin this year. Unless the two can agree on contract terms by the end of the year, some Blue Shield customers who […]
Final Medical Loss Ratio Rule Rebuffs Insurance Agents
The Obama administration issued a rule today that is sure to disappoint insurance agents: Fees paid to brokers and agents won’t count as medical care, under limits imposed on insurers in the 2010 federal health law. That’s key because under the health law, insurers must spend at least 80 percent of their premium revenue on medical […]
Report: U.S. Outspends Other Countries On Health Care
We’re No. 1. In health spending. Again. The United States far outpaces other countries in how much it spends on health care, although Americans have a lower rate of doctor visits and hospitalizations than most of the other 34 member countries of the Organization for Economic Co-operation and Development. In its Health at a Glance […]
HHS Flags First ‘Unreasonable’ Premium Increase
Updated at 4:35 p.m. with comments from Everence. Everence Insurance of Pennsylvania on Monday became the first insurer flagged by federal regulators for having an unreasonable rate increase. The insurer, a for-profit arm of the Mennonite Church USA, raised rates starting in September by 11.6 percent for its ShareNet policies covering 4,800 people working for […]
The Walmart Opportunity: Can Retailers Revamp Primary Care?
Just as Walmart and other retailers shook up the pharmacy business by offering $4 generic drugs, the industry now aims to apply its clout to tackle unpredictable costs, a lack of primary care doctors and inefficient management of chronic illnesses.
Does Walmart aim to be a major player in the world of primary care health services – or not? A request for information letter the retailer sent to its strategic partners in late October says the firm wants just that – but Walmart backed off on its own document Wednesday, calling part of it “overwritten […]
Walmart Wants To Be Nation’s Biggest Primary Care Provider
According to confidential documents obtained by KHN, Walmart is seeking to become the largest provider of primary health care in the United States in order to “lower the cost of health care.” Analysts say Walmart could also be trying to get more people in their stores.
Big Insurer Fights Back In Court Against Regulation Of Profit Margin
The case brought by Anthem Health Plans of Maine could have regulatory repercussions around the country.
CLASS Dismissed: Obama Administration Pulls Plug On Long-Term Care Program
KHN staff writers Julie Appleby and Mary Agnes Carey report that federal officials have effectively shut down part of the health care law aimed to help consumers pay for long-term care.
Advisory Panel Says Essential Health Benefits Package Must Be Affordable
The Department of Health and Human Services now must decide what benefits should be required in policies sold through insurance exchanges beginning in 2014.
Costs Of Employer Insurance Plans Surge in 2011
An annual survey has found that the average cost of a family health insurance plan rose 9 percent this year – triple the growth rate seen in 2010. KHN’s Julie Appleby filed this story.
Companies Steering Workers To Lower Priced Medical Care
Businesses want employees to be more sensitive to the cost of medical care, but consumer advocates worry that decisions will be based on price, not quality.
Trade Group, Other ‘Association’ Health Plans To Face Rate Hike Scrutiny
Insurers who offer “association health plans,” which are often sold through trade groups or other organizations of affiliated members, will face the same scrutiny of premium rate hikes as other types of insurance, federal officials said Thursday. The decision came in a rule clarifying that insurers offering association health plans will be required to provide justification […]
N.C. Employers Embrace Medicaid Medical Home Network
North Carolina employers are trying to find out if there really is no place like home. As in medical homes, that is. For the first time, people with job-based insurance in the state will soon be offered a chance to tap into a well-known medical home network that has primarily served Medicaid enrollees since 1998. […]
