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The commercial healthcare segment is consolidating in the Heartland, where dominant Blue Cross plans hold their solid top positions, and players such as Coventry are buying up regional plans in hopes of gaining economies of scale. New emphasis on medical homes and other care coordination initiatives have healthcare providers and insurers making transformative decisions. Medicaid programs are seeing their rolls continue to swell, but struggle to fund services even with the recent extension of federal funds–so they're turning to the few choices they have to create savings, including prescription drug management, provider rates, and extending managed care.

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