Policy & Regulation
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Payer participation in ACA exchanges lacks in parts of US
In the Northeast, 40% of the population lives in an area with at least five ACA plan payers. That figure is only 4% in the South, according to the Urban Institute.
By Les Masterson • March 22, 2019 -
GAO finds 'small number' of payers dominate private, ACA markets
The three largest payers in most states owned 80% or more of the private market in 2016, with even more concentration in state ACA exchanges up to 2017, the watchdog agency said.
By Tony Abraham • March 22, 2019 -
MIPS participation in year 1 nets 95% of eligible clinicians
Of those participating in the Merit-based Incentive Payment System in 2017, 93% earned a positive payment adjustment, according to a new CMS report.
By Meg Bryant • March 21, 2019 -
Most health apps share data with third, fourth parties, BMJ analysis warns
"Clinicians should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent," the study authors wrote.
By Meg Bryant • March 21, 2019 -
Several states in CMMI model made 'significant strides' in pop health integration
A new report on the progress of the State Innovation Model found participating states focused on value-based payments, along with integrating behavioral, physical and population health.
By Les Masterson • March 21, 2019 -
Sage's postpartum depression drug is approved. Now comes the hard part
Zulresso's label requires women to undergo a 60-hour infusion and only in certain settings, factors that may hamper the drug commercially.
By Jacob Bell • UPDATED: March 20, 2019 at 9:12 a.m. -
Big changes to substance abuse privacy rule coming, sparking renewed debate
Some providers argue Part 2 is redundant and overreaching. HHS Deputy Secretary Eric Hargan called the rule "onerous" last week and hinted a rework is coming soon.
By Shannon Muchmore • March 20, 2019 -
Payers, employers pitch fixed reimbursement rates for out-of-network providers to curb surprise billing
Hospital groups quickly slammed the proposal as "a dangerous precedent" that could "create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks."
By Les Masterson • March 19, 2019 -
Physician-led ACOs leaving Medicare program in greater numbers
The vast majority of ACOs have stayed with the Medicare Shared Savings Program, however, with only 13% of them dropping out last year.
By Les Masterson • March 18, 2019 -
Direct enrollment for ACA plans may lead to higher costs, fewer protections
The Center on Budget and Policy Priorities warned that direct enrollment through entities other than HealthCare.gov or state exchange websites stifles competition and can confuse and mislead consumers.
By Les Masterson • March 18, 2019 -
Medicare, Medicaid advisory commissions alarmed by DSH cuts
The latest reports to Congress from the payment advisory commissions call for a sweeping redesign of quality measurement programs and signal concern for the financial viability of disproportionate share hospitals.
By Tony Abraham • March 18, 2019 -
Short-term plans, Medicaid waivers, MA benefits dominate AHIP conferences
A House panel is investigating short-term "junk plans" and payers look to take advantage of more flexible benefit options in Medicare Advantage. That (and more) from AHIP's dual conferences last week.
By Shannon Muchmore , Rebecca Pifer • March 18, 2019 -
Medicaid work requirements will hurt hospital finances
Meanwhile, this week Trump administration officials argued in defense of the work requirements in front a skeptical federal judge who already halted the regulation in Kentucky.
By Les Masterson • March 15, 2019 -
Telehealth underused by federally qualified health centers, analysis finds
Centers use telehealth largely for behavioral health sessions with patients, though some store-and-forward activities and remote patient monitoring also occur, according to the report by RAND Corporation.
By Meg Bryant • March 14, 2019 -
State-run reinsurance programs helped lower ACA plan premiums by 20%
The seven states using reinsurance have saved the federal government almost $1 billion, according to a new report from Avalere.
By Les Masterson • March 14, 2019 -
PBMs called to give patients 'an explanation' by Senate panel
Cigna, CVS Caremark and CVS Health, Humana, UnitedHealth's OptumRx and Prime Therapeutics got invites to the latest Senate Finance Committee hearing. The panel said two of the companies have so far agreed to testify.
By Shannon Muchmore • UPDATED: March 19, 2019 at 4:02 p.m. -
AMA says prior authorizations increasing, interfering with care continuity
A new survey of 1,000 physicians found that more than two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization.
By Les Masterson • March 13, 2019 -
House panel to launch investigation into short-term 'junk' plans
The Committee on Energy and Commerce will probe companies offering the short-term coverage and "hold them accountable," said Chairman Frank Pallone, D-N.J., including those run by UnitedHealth and Anthem.
By Rebecca Pifer • March 13, 2019 -
HHS hints at cutting 'onerous' substance abuse record rules
Deputy Secretary Eric Hargan told attendees at AHIP's National Health Policy Conference to "watch this space very carefully" for changes to the law known as Part 2.
By Rebecca Pifer • March 13, 2019 -
Hospital groups say public option would cut payments by 10%
The American Hospital Association and Federation of American Hospitals argue an opt-in government insurance plan would hit bottom lines and disrupt the insurance market.
By Tony Abraham • March 13, 2019 -
Trump admin proposes massive cuts to Medicaid, Medicare
Nearly all items on the wishlist hold zero chance of becoming law, but will likely give Republicans a headache come election time.
By Rebecca Pifer • March 12, 2019 -
Population health program growth sputters, though execs agree they're needed
The potential of losing money in risk-based contracts is the most significant reason health systems are resistant to move into value-based care, according to a new Numerof & Associates report.
By Les Masterson • March 12, 2019 -
Pharmas, PBMs and payers all take a slice along drug supply chain, Pew says
As pharmaceutical spending and PBMs take fire in Washington, the report aims to suss out the players pocketing a share as drugs make their way through the system.
By Les Masterson • March 11, 2019 -
MedPAC eyes changes to ED coding, Part B drug pricing
Meanwhile, MACPAC discussed how shortfalls should be counted for Medicaid patients with third-party coverage in the DSH program.
By Les Masterson • March 11, 2019 -
Nashville program looks to tackle uncompensated care costs
The plan comes two years after then-Mayor Megan Barry proposed closing Nashville General as an inpatient facility. About 15% of the city's residents are uninsured or underinsured.
By Les Masterson • March 08, 2019
