The pursuit of value with risk models

Matt Siegel, Verisk Health

The proliferation and variety of accountable care designs in commercial insurance, Medicare Advantage and managed Medicaid highlight the need predict the appropriate cost of care, ensure access to needed services and raise quality. But how can value be measured?

Will stricter controls on painkillers curb abuse and addiction?

G Caleb Alexander, Kevin Fain, Matthew Daubresse

Americans consume a staggering amount of the opioid painkiller hydrocodone, about 99 percent of the world's supply. In October, after 10 years of debate the Drug Enforcement Agency (DEA) reclassified medications like Vicodin, and products that combine hydrocodone with other drugs, as Schedule II controlled substances.

Feature Video

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.


Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

The former chief financial officer of a now-closed Texas hospital is one step closer to a potential five years in federal prison after pleading guilty to wrongly claiming EHR incentive money.

The Sunshine State's largest health insurer is betting on a well-branded telehealth service with a retail experience.

A tension between transparency and trade secrets has surfaced in North Carolina, where the state's largest insurer believes a new disclosure law will have unintended consequences.

The Obama administration took another step to close what many see as a health-law loophole that allows large employers to offer medical plans without hospital coverage and bars their workers from subsidies to buy their own insurance.

The Medicaid private option policies designed to insure low-income individuals through a more market-based system is showing early signs of success, but also hurdles.

California's experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance.

Want to pay your health plan premiums while picking up medications, buying some batteries (or maybe a piece of chocolate) and getting a free cholesterol screening? Humana is betting that retail convenience will support its individual membership business.

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