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Social risk factors may influence CMS star ratings, study suggests
Providers have disputed the methodology CMS uses to compile its star ratings for years, saying the approach is overly simplistic and the presentation of data to consumers is difficult to interpret.
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Insurance startup Bright Health eyes California with 1st payer acquisition
The deal is the company's first buy of another health insurer and a pivot to M&A as it pursues an aggressive growth strategy.
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Kaiser, major union launching nonprofit to boost California workforce
The $130 million organization, called Futuro Health, has a goal of graduating 10,000 new licensed and credentialed workers for the state in the next four years.
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Molina expands Illinois footprint with $50M acquisition
The buy of NextLevel Health Partners, if approved, would give Molina more members in Cook County.
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US cancer death rate drops by most on record
Reductions in smoking and earlier cancer detection have driven death rates lower, but newer treatments could be playing a larger role, too.
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Walgreens centers strategy on cost cuts
The chain saw retail prescription market share on a 30-day adjusted basis decrease and comparable retail sales fall 0.5% in the quarter, mostly due to continued de-emphasis of tobacco.
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Digital health M&A flatlined in 2019, but IPO activity promising
Rock Health sees creation of remote patient monitoring reimbursement codes and progress on data blocking rules as potential growth catalysts for the sector.
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DOJ joins whistleblower suit against Indiana system for alleged Stark violation
Community Health Network is accused of submitting as many as hundreds of thousands of fraudulent claims to Medicare and other federal programs from at least 2008 to 2017.
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Individual market appears stable despite lack of mandate penalty
Claims costs in the first nine months of 2019 grew and average hospital time dipped, indicating the market didn't have disproportionately sicker patients, according to the Kaiser Family Foundation.
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Ex-Anthem exec Brad Smith appointed head of CMS innovation center
Smith, previously co-founder and CEO of palliative care company Aspire Health, replaces outgoing CMMI head Adam Boehler.
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HCA takes stake in major private nursing school operator
The nation's largest hospital operator said the buy of the parent company of Galen College of Nursing will help foster a pipeline.
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Latest FDA clinical decision support software draft a step forward, industry says
Still, the American Medical Association wrote the guide could "lead to the proliferation of CDS tools for 'non-serious conditions' that are faulty, inaccurate, and without validation, potentially leading to patient harm."
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CMS proposes using more encounter data for MA risk adjustment
The mix of encounter data used to calculate payments would go up to 75% next year under the proposed regulation. Payers have railed against previous increases, saying the information is inaccurate and unreliable.
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Beaumont, Summa sign merger agreement to form $6.1B nonprofit
The deal, expected to close in the first quarter of this year, would create a 12-hospital system spanning Michigan and Ohio.
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Beyond the ACA: Healthcare legal fights to watch in 2020
Payers and providers are contesting a price transparency push. The Trump administration is also being challenged over risk corridor payments and the expansion of association health plans.
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Primary care chain One Medical files to go public
The company reported a $34.2 million loss through the first nine months of 2019. Investors include The Carlyle Group with a roughly 27% stake and Google parent Alphabet with about 6%.
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Providers embrace loosening Stark Law regulations, suggest feds could go further
The Trump administration's proposed relaxation of regulations around the law has nearly unanimous support in both the hospital and physician community, most of whom say they are chafing against the requirements.
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Supreme Court says ACA opponents have until Friday to respond to motion to expedite
The court set the deadline Monday after a push by the law's supporters to have the case heard before this year's presidential election.
UPDATED: Jan. 7, 2020 at 10:35 a.m. -
In win for big payers, appeals court sides with HHS in risk adjustment case
AHIP and the Blues argued it would be inconceivable to come up with an entirely new formula for the payments created under the Affordable Care Act.
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Despite provider claims, hospital M&A not associated with improved care, NEJM finds
The findings refute a common provider justification for rampant M&A, but the American Hospital Association pushed back on researchers' reliance on patient surveys.
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Pfizer, AbbVie and Gilead among drugmakers boosting prices to start 2020
List prices rose on some of the top-selling medicines in the U.S., including Humira, Opdivo, Prevnar 13 and Biktarvy.
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Illumina scraps $1.2B PacBio takeover amid regulatory pushback
Cowen analysts listed Agilent, Danaher and Thermo Fisher as potential buyers of Pacific Biosciences.
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Google AI tool bests clinicians in breast cancer detection study
The findings published in Nature come as clinicians remain skeptical of the tech's efficacy in the exam room.
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Hospital margins dipped in November as expenses rose
Volumes fell across most measures including adjusted discharges, emergency department visits and operating room minutes.
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Tenet deal to sell Memphis properties raises hackles of other area providers
One health system said it is "reasonably certain the FTC will be reviewing this proposed transaction given the potential negative impact it could have on the consumers in Memphis."
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