Payers

Commercial insurers, the employer and individual market, plus Medicare trends, Medicare Advantage, & Medicaid managed care

The Payers’ Playbook
Joseph Burns
Neeraj Sood
Employers and health insurers are asking consumers to put ‘more skin in the game’ with high-deductible health plans but don’t provide incentives for them to choose high-value care.
The Payers’ Playbook
Joseph Burns
The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review the entire medical record?
Fresh Faces
Frank Diamond
The CMO of Molina Healthcare of Utah grew up, let’s say, not rich. He says that and a varied background—including a stint in the Air Force—helps him deal with changing policies involving a challenging population.
Sarah Kwon
Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.
Q&A
Interview by Peter Wehrwein
Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever.
Women’s Health
Lola Butcher
High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care.
The Payers’ Playbook
Joseph Burns
A MedPage Today blog post suggests that they do. Industry veterans say they’re unaware of bonuses for denials but agree prior auth processes should be more transparent.
Vox medical directorae
Lola Butcher

They are all physicians. They all want to take care of people. But the chief medical officers at health plans and provider organizations often see the world through different lenses. Here, chief medical officers from both sides of the divide share their views.