Three major insurers — Anthem Blue Cross and Blue Shield, Humana and UnitedHealthcare — have teamed up with 11 local physician group practices and a local organization to pilot a patient-centered m…
Minnesota health plans are facing the specter of rising specialty drug costs and are implementing a variety of strategies to control those costs, including shifting specialty drugs from the medical be…
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Pennsylvania stands out from most states because of the dominance of four Blue Cross Blue Shield plans that operate, for the most part, exclusively in their own territories. Whether the Blue plans’ un…
Kansas Medicaid members could face a preferred drug list and a streamlined prior authorization process, which could widen the number of therapeutic classes the state covers. These changes are borne ou…
South Carolina's expanded Medicaid managed care program attracted a crowd of health plans interested in insuring beneficiaries, but the crowd is thinning with two MCOs throwing in the towel in 200…
Wisconsin state officials are dictating to state HMOs that changes be made in how care is delivered in the state's Medicaid/BadgerCare Plus program. Faced with unacceptable HMO quality scores as w…
Texas has taken its largest step yet toward addressing the nation's worst uninsured rate by green-lighting the first step toward Healthy Texas, a reinsurance program that could allow small busines…
With the economy hitting California hard, the pressure is on more than ever for health insurers to respond to the small employer group market, in particular, with plan designs that get the premiums do…
Biologics used to treat immune diseases cost much more than their small-molecule counterparts, and so their use involves costs disproportionate to the number of patients treated. As a result of thi…
A significant medical home pilot program has begun in the Phoenix and Tucson areas in which UnitedHealthcare is offering additional payments for primary-care providers involved in the treatment of pat…
Colorado has kicked off a broad medical home project in 17 primary care practices around the state. Those physicians will receive standard fee-for-service, a monthly care management fee and bonuses fo…
Fallon Community Health Plan, based in Worcester, Mass., is reacting to local market dynamics in announcing its intention to expand into neighboring New Hampshire. The Massachusetts market is dominate…
As many as seven patient-centered medical home projects have cropped up throughout Ohio with CareSource working with providers on a Medicaid-focused PCMH. A medical-home initiative in Cincinnati inclu…
Recent moves to better control pharmaceutical expenses at the large TennCare program for Medicaid beneficiaries have resulted in compliance to preferred drugs by about 98 percent of the program's…