The Latest
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Tufts, Harvard Pilgrim say they intend to merge
The yet-to-be-named combined nonprofit payer will serve 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island.
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SponsoredThe US has fantastic health care, the problem is….
CEO Dr. Wyatt Decker discusses his perspectives on the challenges and opportunities for reinventing health care.
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Most providers not fully compliant with HIPAA access requirements, research shows
The most common problem was providers not sending health records via email when patients requested them. About a quarter of providers were also potentially noncompliant with the health privacy law's fee limitations.
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Hospitals facing likely DSH payment cuts after appeals court ruling
A federal appeals court reinstated a 2017 rule allowing Medicare and private insurance payments to be included in how Disproportionate Share Hospital reimbursements are calculated.
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Average marketplace premiums for 2020 show smallest increase ever
Rates are expected to rise very modestly for those shopping for individual coverage. Colorado will actually see a decrease in average premiums, according to a report from Charles Gaba of ACASignups.net.
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UnitedHealth Group report targets rising hospital prices
The insurer said inpatient prices rose 4.5% annually from 2013 through 2017 — even though consumers' use of inpatient care dropped 5%.
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CMS says it wants to cut paperwork. Providers have ideas.
Companies took the agency's request for information as an opportunity to air perennial grievances, including inequitable quality measures, cumbersome prior authorization and problems with interoperability and telehealth.
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Tweaking CMS model variables can improve payment estimates, JAMA study finds
Researchers looked at how to improve predictions for three conditions: acute myocardial infarction, heart failure and pneumonia.
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Centene expands ACA offerings in 10 states
About 2 million people have health insurance coverage through the insurer's exchange products. The expansion in 10 markets will likely boost that figure.
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Hospitals bash immigration rule likely to push millions off Medicaid
The American Hospital Association called the policy aimed at legal immigrants "misguided and harmful" and said it creates barriers to care.
UPDATED: Aug. 14, 2019 at 9:02 a.m. -
SponsoredCross-industry collaborative develops guiding principles for the ethical use of social determinants of health data
eHealth Initiative Foundation released five guiding principles that traditional and non-traditional healthcare entities should follow.
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ACA market continues to lose those who don't qualify for financial help
Six states lost 50% or more of their unsubsidized population, or people who don't qualify for financial help. Iowa lost 85% of such customers.
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Rite Aid names new CEO
Heyward Donigan is a seasoned healthcare executive, suggesting that the drugstore will join rivals in emphasizing medical services over retail.
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Large employers look to virtual care to tackle high-cost claims in 2020, survey finds
The total cost of health benefits is expected to increase by 5% in 2020, in line with 2019. Of the 147 companies polled, 85% said expensive drugs were a top pharmacy-related concern.
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Surprise bills surge in ER, inpatient settings, JAMA finds
The study comes as lawmakers prepare to debate legislation tackling the problem, including a Senate bill that sets a payment standard for out-of-network services. Providers are pushing back.
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Kaiser Permanente net income soars to $2B
The integrated health system said the first half of the year typically delivers stronger results due to open enrollment.
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Allscripts reaches $145M settlement with DOJ over subsidiary business practices
The Chicago-based health IT vendor reported a $145 million charge to settle claims that its Practice Fusion unit falsified EHR certification and violated anti-kickback laws.
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Lack of tech, not jobs, could ding Medicaid enrollees facing work requirements
A large proportion of enrollees in the 16 states attempting to impose work requirements on Medicaid beneficiaries already have jobs or are providing care for someone in their household, according to the Kaiser Family Foundation.
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North Carolina folds to provider pressure with insurance plan shifting away from set rates
The new hybrid network will consist of more than 68,000 providers. The initial proposed State Health Plan network included only 28,000.
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Louisiana drops Aetna, Centene plans from 2020 Medicaid managed care contracts
The state public health department dropped the two vendors, which manage benefits for roughly a third of the state’s 1.7 million Medicaid enrollees.
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Q&ACalifornia's AG on future of ACA suit, CVS-Aetna union
Xavier Becerra talked to Healthcare Dive about suing Sutter, J&J and what could be his most influential case yet: defending the Affordable Care Act.
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ColumnMyth Diagnosis: Do hospitals charge more to make up for low government pay?
"What is crystal clear is that there's a huge unit cost payment differential between government and commercial payers," John Pickering of Milliman said. "What isn't clear is whether there's a causal effect between those two."
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Apple, Eli Lilly research whether devices can detect dementia signs
The two companies, along with health tech startup Evidation, found promising initial results but concluded additional research is needed.
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Primary care, younger docs more likely to report burnout
Only a quarter of survey respondents said their work sites effectively address the challenge, citing initiatives to improve workflow and reduce administrative burden, provide flexible scheduling and support wellness.
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Healthcare AI funding hits new high as sector matures
Startups in the sector raised $864 million across 75 venture capital-backed deals and financing during the second quarter, beating the previous quarterly high by about $100 million.
