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

Timothy Kelley
Medical directors have been around for a long time. Today, to reflect expanding duties, there’s a bewildering array of other titles too. Are we all agreed on what titles mean, then? No way. For example: Many executives who are called CMOs—or something else—are also taking on the new duties of value-based care.
Joseph Burns
The company has more than 15,000 employees—or about a third of the eligible employees in those four locations—enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
Jan Greene

Some health plans responded by making it easier to see an out-of-network doctor, get a new copy of an insurance card or replace prescriptions lost in the chaos. Insurers also set up telephone help lines and made it easier to get a referral to a specialist.