Even Small Employers Are Striking Out on Their Own.

Several factors are at work. Group health insurance got more expensive when the ACA mandated essential health benefits and no-cost preventive care. Some small companies dropped coverage altogether, but now they are coming back into the fold as the employment market has tightened up, say brokers. Starting fresh, they have a chance to consider self-insurance.

EDs Getting Ready To Dive Into Value-based Payment Waters.

The American College of Emergency Physicians pushes a payment model that would have ED doctors tracking patients for 30 days after discharge. CMS may adopt it for Medicare. Meanwhile, emergency medical groups interested in participating will need to learn the ropes of care coordination.

Interopera-impossibility?

CMS wants Medicare Advantage plans to provide enrollees with immediate access to their health information starting in 2020. But you can't always get what you want. Insurers are especially worried about programming interface software that will allow their databases to share information with third parties, such as mobile apps.

Air Ambulance Turbulence: Consolidation, Cost Shifting, and Surprise Billing.

It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.

The Growing Appeal of On-the-job Health Care.

The clinics range in size from a nurse who shows up in a mobile unit a few hours per week to a large-scale, full-service health clinic with multiple primary care providers and clinicians who can provide dental and vision care.

U.S. Women's Health: Not So Great.

The Commonwealth Fund reports that U.S. women have more chronic illness, are less satisfied with their care, and have more trouble affording it-often skipping needed care because of cost-than women in comparable nations. Could universal coverage be the cure?

HRT Has an Uncertainty Problem. Does Compounding Make It Worse?

Hormone replacement therapy (HRT) has been around since the 1960s to help menopausal women who struggle with symptoms caused by the ebbing of estrogen. In 2002, a major study said that HRT could raise cardiovascular and breast cancer risks. Enter compounding. Too risky?

Nurse Practitioners to Docs, Lawmakers: Give Us Our Independence.

And that means full scope of practice as primary care providers. Medical societies hate the idea and think that nurse practitioners need to be tethered securely to a physician office in order to ensure top-notch care. Nurse practitioners counter that they can help shore up primary care.

Taming the Gene Genie.

Genetic tests are all the rage, but insurers are well aware of the downside. Genomics is complicated, and test results are often couched in uncertainty and loaded with caveats. The tests available to consumers may not be clinical quality, so if something questionable pops up, the tests need to be redone anyway. A positive result could also lead to a cascade of additional, expensive, and potentially risky diagnostic tests.

Dividing Diabetes by Cluster Instead of Types.

Breaking up type 2 diabetes into subtypes has been something that clinicians and researchers have discussed and debated for years. Swedish researchers have proposed a new taxonomy to do just that. If it takes, the trick will be to come up with treatment plans that fit individual patients based on these more precise diagnostic categories.

When Value Is in the Eye Of the Patient.

Physicians and their charges have different ideas about what makes for good cancer care. Patient surveys help, but they need to be handled right.

The Pap Test: 20th Century Success Story, 21st Century Has-Been.

This old standby's ultimate demise will likely take place when cervical cancer incidence declines as the HPV vaccine starts to take effect at a population level. New guidelines are being written, but insurers could have a major influence on how closely those guidelines are followed. So far, though, they haven't waded very far into the Pap-HPV debate.

Who Pays To Care for the Seriously Ill? Maybe It's Insurance Companies.

Palliative care would fill a need and could save health care dollars in the process. But providers often need to patch together CPT codes to get paid for it.

Nurse practitioners provide quality primary care at a lower cost than physicians.

The growing need for primary care providers has opened the door for nurse practitioners to fill the void. Nursing students are rushing to get nurse practitioner degrees, and researchers are working to keep pace with studies. Most of the results provide evidence for expanded use of nurse practitioners in a variety of settings.

Palliative care improves quality of life and symptoms.

Offering emotional and physical comfort to seriously ill and dying people-the heart of palliative care-certainly seems like the right thing to do. Advocates think so and there's now a body of evidence to support the provision of palliative care services, especially in hospitals.

Why drug prices will continue to roil the waters-and why Scott Gottlieb, MD, will be in the center of the action.

We'll see what happens to the administration's Part B proposal. Congress is not likely to take bold action, partly because drugmakers are a strong influence on both parties. That leaves the FDA and Administrator Scott Gottlieb, MD, as major players in efforts to rein in drug prices.

Why employers are offering more choices in health plans next year.

It's a tight labor market and employer surveys show a modest but steady uptick in employer health benefit spending for the coming year-about 5% on average. Much of that increase will go toward specialty drugs, the benefit with the biggest price hikes.

ACA Repeal, Part 2: Star Turn for State Regulators as Insurance Markets Will Continue To Be a Partisan Battleground.

Whether in a red or blue state, the state commissioner jobs do require decent working relationships with insurance companies, particularly in precarious times as insurers threaten to leave some areas with no ACA coverage because of poor market conditions or dithering in Washington, D.C.

Insurers Relax Rules, Help Members After Hurricanes Harvey, Irma.

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.

Fee-for-Service Is Dead. Long Live Fee for Service?

The move to a value-based payment system was supposed to end perverse incentives that pay doctors more for delivering often unnecessary services. But things are changing slowly and the market is still 95% fee for service. There's talk of reworking the Medicare fee schedule so docs are paid more for the things that work, and less for those that don't.