Health Care Delivery

The Medicare, Medicaid, and Dual Eligibles programs are on the verge of a significant transition under the Affordable Care Act. Coordinating care and improving population health outcomes will require these federal programs to move away from outdated fee-for-service models to ones that incent better quality and more cost-effective delivery methods. At America's Health Insurance Plans (AHIP) Medicare, Medicaid, and Dual Eligibles conference held on September 23-26 in Washington, DC, the sessions featured discussions that highlighted the role health insurance plans will play as these federal programs continue to evolve under healthcare reform.

We are in the midst of exchange implementation-the centerpiece of the affordable care act-and it seems a good time to take stock of where we are and need to go. The ACA has validated and spurred on existing efforts. We are making progress on many fronts but fundamental changes are still needed to deliver on the promise of better value.

Hackensack Alliance ACO integrates pharmacists and adopts new technology as it joins in the bold experiment to lower costs and improve quality under health reform.

Horizon Blue Cross Blue Shield of New Jersey said Tuesday it won't renew any of its 2013 policies for individuals and small-business owners after the end of the year because it would be next to impossible to undo the work it has put in preparing for Obamacare.

More than 100,000 individuals selected a private insurance plan through the federal online marketplace in November, HHS announced Wednesday. That's roughly four times the enrollment total during October, when the HealthCare.gov website was largely dysfunctional. But it was far short of the levels needed to meet the Obama administration's projection of 3.3 million enrollees by Dec. 31.

Richard Umdenstock, president and chief executive officer, American Hospital Association (AHA), says hospitals have been preparing themselves for the influx of newly insured since 2010.

States' refusal to expand their Medicaid programs could cost billions of dollars over the next 10 years, and those costs are staggering.

The downward trend in preventable hospital readmissions that began in 2012 has continued well into this year, according to data published Friday on the CMS' blog. Quality experts were impressed but had questions.

Reference prices, a health benefit strategy that requires patients to pay costs above a set price, may save employers and patients money, but their potential may be limited-perhaps even more so under the Patient Protection and Affordable Care Act.

The Affordable Care Act has dramatically increased the cost of buying a health insurance plan on the individual market in California, Texas, Florida, New York, Illinois, Georgia, and North Carolina, states that account for more than half of America's uninsured adults.

About 29,000 people successfully navigated HealthCare.gov and selected an insurance plan on Sunday and Monday, more than the entire number of people who were able to enroll through the federal exchange during the month of October, according to a person familiar with the project.

The individual mandate of the Affordable Care Act was intended to incentivize uninsured Americans into purchasing health insurance on the exchanges. However, latest findings show that the penalty may not be enough.

President Obama leaves the White House on Wednesday for one of the capital's most struggling neighborhoods to talk about the economy, not simply to divert attention from his troubled Affordable Care Act but to explain how that law, for all of its flaws, fits into his vision for Americans' economic security and upward mobility.

By all accounts, the shopping experience on HealthCare.gov has improved significantly. That means customers can routinely access information about what health plans and subsidies are available and select the product of their choice.

Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program's high costs and inefficiency.

Much of the healthcare spotlight has been squarely focused on the federal and state implementation of the Affordable Care Act (ACA). Yet, there is another fundamental shift in policy that is occurring at the private level that will change the way health insurance is offered to consumers.