Policy & Regulation
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Payers transition to government health plans despite risks
Commercial health plans have dropped over the past 10 years as payers move to managed Medicaid and Medicare Advantage.
By Les Masterson • Aug. 16, 2018
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Insurance brokers expect higher ACA plan premiums, market instability
Brokers predict more people will leave individual insurance for lower-cost options like short-term health plans and association health plans.
By Les Masterson • Aug. 16, 2018
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FDA sets out vision to use real-world data in product evaluations
The agency wants insights into safety and efficacy outside of controlled research environments.
By Nick Paul Taylor • Aug. 16, 2018
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Partial Medicaid expansion would restrict access for near-poor adults, study finds
Wisconsin is the only state so far to partially expand the program, but at least three other states are considering such a proposal, according to a Center on Budget and Policy Priorities report.
By Les Masterson • Aug. 15, 2018
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Deep DivePrior authorization moves to EHRs
Manual prior authorization can create administrative burdens for practices and hospitals, but case studies show some success in making the process electronic.
By Les Masterson • Aug. 15, 2018
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Nearly 20% of inpatient admissions include out-of-network charge
A Kaiser Family Foundation report found the issue of surprise billing is especially problematic for care in ERs and for psychological or substance abuse treatment.
By Les Masterson • Aug. 14, 2018
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AHA continues to push HHS on Medicare billing backlog
AHA and three member hospitals are suing the agency and in the latest court filing suggested methods for reaching a court-ordered 2020 deadline for getting through the claims.
By Les Masterson • Aug. 14, 2018
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Telling doctors about their patients' opioid deaths curbed prescriptions
A letter from the San Diego County medical examiner resulted in lower high-intensity prescribing, fewer opioid prescriptions and overall lower opioid intake, according to an analysis.
By Les Masterson • Aug. 13, 2018
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Primary care docs easier to find in ACA plans than Medicaid, study finds
Physicians are even more likely to participate in employer-sponsored health plans, according to the Health Affairs report.
By Les Masterson • Aug. 13, 2018
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In first, FDA approves RNA interference drug from Alnylam
Alnylam's drug, called Onpattro, will carry an average annual list price of $450,000, although the biotech expects rebates to bring the net price down by a fifth.
By Ned Pagliarulo • UPDATED: Aug. 10, 2018 at 4:13 p.m.
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FDA OKs marketing of contraceptive app
The Natural Cycles app has generated controversy in Europe, where women have reported unplanned pregnancies while using it.
By Susan Kelly • Aug. 13, 2018
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CMS proposes Medicare ACO revamp to force risk
Proposed changes to the Medicare Shared Savings Program, a cornerstone of the Affordable Care Act, would force accountable care organizations to take on risk sooner. Critics fear this will chase participants out of the program.
By Tony Abraham • Aug. 10, 2018
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Massachusetts fumbles on telehealth parity bill
Last year, the American Telemedicine Association gave the state an F on telehealth parity.
By Meg Bryant • Aug. 09, 2018
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AMA charges CVS-Aetna deal would reduce competition
The analysis came as Bloomberg reported that the Justice Department won't oppose the merger based on vertical competition issues, although it may still be looking at how it will affect the pharmacy market.
By Les Masterson • Aug. 09, 2018
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CHS under EHR meaningful use investigation
The Franklin, Tennessee-based provider is the latest to face scrutiny from federal investigators regarding the use of EHRs.
By Rebecca Pifer • Aug. 09, 2018
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CVS rejects pharma claim that rebates push up drug prices
Responding to charges that PBMs pocket much of drug rebates, the pharmacy giant said it retains only 2% of the price concessions from drugmakers.
By Ned Pagliarulo • Aug. 09, 2018
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ACOs using medical home physicians save money, yield higher quality, report finds
"ACOs and patient-centered medical homes are cut out of the same cloth," Robert Mechanic, executive director of the Institute for Accountable Care, said about the research.
By Rebecca Pifer • Aug. 08, 2018
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Small, medium payers show growing interest in provider-sponsored plans
A new white paper looked at that payer marketplace niche, which has seen significant turnover in the past five years.
By Les Masterson • Aug. 08, 2018
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CMS to allow step therapy in MA plans in bid to boost price competition
Dan Best, CMS senior advisor for drug pricing reform, told reporters the policy could save 15-20% of the $12 billion annual spend by MA plans on oft-pricey Part B drugs. Not all analysts buy that estimate.
By David Lim • Aug. 08, 2018
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Market concentration tied to higher premiums in ACA markets, study finds
Premiums in marketplaces with monopolist insurers were 50% higher than in markets with more than two insurers, according to a Health Affairs report.
By Meg Bryant • Aug. 07, 2018
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CMS' Verma stands firm on 2015 EHR deadline, move to open APIs
Meanwhile, the coalition Health IT Now sent a letter to ONC chiding the government for failing to implement information blocking provisions of the 21st Century Cures Act.
By Meg Bryant • Aug. 07, 2018
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Drugs make up more US health spending than thought, report suggests
Research published in Health Affairs found that drugs accounted for 15% of the country's total healthcare spending in 2016, higher than the oft-cited 10% figure.
By Ned Pagliarulo • Aug. 06, 2018
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More employers look toward value-based insurance plans
After years of implementing cost-sharing policies like the use of high-deductible plans, businesses are looking for new avenues to reduce costs and improve health.
By Les Masterson • Aug. 06, 2018
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CMS finalizes rule requiring hospitals to post prices online
The inpatient rule also cuts reporting periods down to 90 consecutive days, nixes the 25% threshold policy for long-term care hospitals and cuts a number of reporting measures.
By Tony Abraham • Aug. 03, 2018
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Healthcare M&A remains hot, but value fell in Q2
Despite the activity, there was only one industry megadeal in the quarter — KKR's $10 billion buy of Envision.
By Les Masterson • Aug. 03, 2018