Finances: Page 72
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Major payers unlikely to see financial hit from risk-adjustment halt, Fitch says
But the decision to halt the payments is likely to destabilize the individual market, according to the ratings agency.
By Les Masterson • July 16, 2018 -
Docs shouldn't be held accountable for healthcare costs, NEJM survey finds
Industry experts say out-of-pocket costs are important to patients but there are multiple barriers to properly educating them about healthcare pricing.
By Les Masterson • July 16, 2018 -
HHS OIG cites flawed efforts to prevent fraud in Medicaid managed care
A new report found that not all managed care organizations use proactive data analysis or inform states when providers are suspected of abuse.
By Les Masterson • July 13, 2018 -
Employer health insurance cost growth cut in half
Potential factors behind the trend include preemptive moves by employers to avoid the Affordable Care Act's excise tax on high-cost plans, cost-shifting and the rise of high-deductible plans, according to a new Mercer report.
By Les Masterson • July 12, 2018 -
CMS will let providers withdraw retroactively from BPCI-A
The agency is not, however, delaying the program's Oct. 1 start date.
By Les Masterson • July 11, 2018 -
Low-quality healthcare persists in high-income countries, report finds
The study found that 10% of patients in high-income countries are harmed during medical treatment and 15% of hospital expenditures in those countries come from mistakes or hospital-acquired infections.
By Les Masterson • July 10, 2018 -
Healthcare startups raise $15B across 779 deals in first half of year
June was a slow month, however, with investments down 3% from the prior year, according to a Pitchbook analysis for Forbes.
By Meg Bryant • July 10, 2018 -
Florida practitioners agree to pay $1.7M to resolve false claims case
FWC Urogynecology reportedly used Medicare billing codes to inflate payments.
By Les Masterson • July 6, 2018 -
Centene completes Fidelis Care buy
The $3.75 billion deal gives Centene a big presence in New York State.
By Meg Bryant • July 6, 2018 -
American Well raises $291M, aims for $315M total
The telehealth operator is partnering with Philips to embed virtual care services in a range of products.
By Meg Bryant • July 5, 2018 -
Deep Dive
The boons of — and barriers to — behavioral health integration
An increasing number of clinics are trying a collaborative care model, but reimbursement, structural and historical barriers remain an obstacle.
By Les Masterson • July 5, 2018 -
Humana, private equity firms complete Kindred acquisition
The agreement separates Kindred into two companies, with Humana picking up a 40% share in Kindred at Home.
By Les Masterson • July 3, 2018 -
Digital health funding sets new H1 record with $3.4B across 193 deals
The sustained growth reflects the sector’s maturation along with a healthy venture ecosystem, a new Rock Health report says. However, despite bullish investment in digital health startup, exits have been slow.
By Meg Bryant • July 3, 2018 -
CMS: Unsubsidized ACA enrollment dropped 20% in 2017
The agency used new data to make their case that federal and state-based exchanges and state individual health insurance markets are in turmoil.
By David Lim • July 3, 2018 -
Drug, device companies gave docs, teaching hospitals $8.4B in 2017
The amount includes $2.82 billion for non-research payments, such as meals, fees and travel to speaking events.
By Les Masterson • July 3, 2018 -
CMS pitches MA demo letting doctors avoid MIPS rules
Administrator Seema Verma said the pilot looks to "put Medicare Advantage on a more equal playing field with fee-for-service Medicare.”
By Les Masterson • July 2, 2018 -
Deep Dive
Return of the house call
Big systems like Johns Hopkins and CMS itself are increasingly looking to home-based care.
By Les Masterson • July 2, 2018 -
Atlantic Health, MedExpress collaborate on urgent care project
The partnership will allow MedExpress’ urgent care patients to get care at an Atlantic Health System facility if advanced care is needed.
By Les Masterson • July 1, 2018 -
Earnings gap between employed, self-employed healthcare professionals narrows
A new JAMA study highlights the trend of physicians moving away from self-employment.
By Les Masterson • June 29, 2018 -
CMS clears Medicaid value-based drug state plan, denies closed formulary
The agency also made clear that drugs approved by the FDA under its accelerated approval pathway must be covered by state Medicaid programs if they are defined as a "covered outpatient drug."
By David Lim • June 28, 2018 -
Most healthcare organizations polled ready for value-based care
The HealthLeaders Media report also found many companies lack the necessary infrastructure to make payment model changes.
By Les Masterson • June 28, 2018 -
Mayo, BCBS deal includes downside risk, prior authorization limits
The five-year contract calls for a collaborative governance structure that would guide care for organ transplants, radiation therapies and genomics.
By Les Masterson • June 28, 2018 -
CMS to step up scrutiny of state Medicaid programs
MLR audits will focus on states "based on the amount spent on clinical services and quality improvement versus administration and profit."
By David Lim • June 27, 2018 -
New partnership aims to launch employer bundled payment programs
Healthcare purchasers are working with Remedy Partners to create a national episode-based payment platform.
By Les Masterson • June 27, 2018 -
GE to spin off healthcare unit in latest restructuring
Moody's and investors applauded the move, which comes amid a reboot of the health division.
By Meg Bryant • June 27, 2018
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