Policy & Regulation
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ACOs with 2-sided risk can cut cost, improve quality, study finds
A Blue Cross Blue Shield of Massachusetts population health program cut per-enrollee spending and resulted in more chronic disease management, according to research in the New England Journal of Medicine.
By Ron Shinkman • July 22, 2019 -
As unprecedented CVS-Aetna review wraps, few clues from judge
Although CVS is now operating and reporting results to Wall Street with Aetna included, the decision could have huge repercussions especially if the judge orders CVS to go beyond Aetna's divestiture of its Part D business.
By Dana Elfin • July 21, 2019 -
Judge upholds short-term plan expansion in Trump win against ACA
The plaintiffs, including the Association for Community Affiliated Plans, the National Alliance on Mental Illness and AIDS United, plan to appeal the decision upholding the controversial policy.
By Rebecca Pifer • July 19, 2019 -
State telehealth use climbing, but barriers to broader adoption remain
North Carolina, Ohio and Montana have distance restrictions on virtual care services, a sign of varying policies among states, according to a new report from a large telehealth trade group.
By Dana Elfin • July 19, 2019 -
High-deductible plans can offer more access to preventive treatment under new rule
Under the guidance, potentially life-saving healthcare services and products used to treat common chronic diseases can be covered as preventive services in high-deductible health plans before enrollees reach their annual deductible.
By Linda Wilson • July 18, 2019 -
Surprise billing legislation saves $7.6B, trims premiums, budget watchdog says
The sweeping Senate bill, which also tackles drug costs and bars certain contracts between payers and providers, was passed out of committee with bipartisan support last week.
By Samantha Liss • July 17, 2019 -
CVS launches home hemodialysis device clinical trial
The drugstore giant, which now includes insurance heavyweight Aetna, said it can help reduce the $35 billion in Medicare costs associated with the treatment of end-stage renal disease.
By Shannon Muchmore • July 17, 2019 -
Surprise billing fight escalates as providers win arbitration add to House bill
Insurers and health policy experts are pushing back against the controversial change to the bill, which will let providers or payers appeal to an independent arbiter in cases where the median in-network rate tops $1,250.
By Rebecca Pifer • UPDATED: July 17, 2019 at 4:11 p.m. -
Intermountain starts new company to spur shift toward value
The effort will be led by Rajesh Shrestha, Intermountain vice president and chief operating officer of community based care.
By Shannon Muchmore • July 16, 2019 -
CMS proposes Medicare cover acupuncture for patients in approved studies
Medicare doesn't usually cover alternative medical procedures, but the government is looking for ways to reduce the nation's dependence on highly addictive opioids for chronic pain.
By Rebecca Pifer • July 16, 2019 -
OpinionAn important first step toward eliminating the transplant waitlist
Global Liver Institute president and CEO Donna Cryer discusses how the U.S. liver transplant system has failed patients — and how President Donald Trump's ambitious new renal care plan could help.
By Donna Cryer • July 15, 2019 -
Participation in APMs, MIPS climbed significantly in 2018
Many physicians have rejected the programs, saying they contain too many rules and rely too much on expensive investments in EHRs.
By Ron Shinkman • July 15, 2019 -
CMS to delay star ratings update pending expert panel review
The agency will convene an expert panel to look at the star ratings system, which is deeply unpopular with providers, and decide whether it's due for a facelift.
By Rebecca Pifer • July 12, 2019 -
Plaintiffs in ACA lawsuit may not have exchange plans. Could that derail the entire challenge?
The two men claim the individual mandate forces them to buy expensive insurance. But they may no longer have minimum essential coverage, raising questions about whether they have standing in the high-profile case.
By Samantha Liss • July 12, 2019 -
Deep DiveACA's legal jeopardy: 4 questions
The embattled landmark law is again before jurists, this time a panel of the Fifth Circuit Court of Appeals. Arguments this week offered more insight into what's at stake.
By Shannon Muchmore , Samantha Liss , Dana Elfin • July 11, 2019 -
FCC approves rural telehealth pilot
The three-year, $100 million program would give an 85% discount on connectivity for broadband-enabled telehealth services that directly connect doctors and patients.
By Shannon Muchmore • July 11, 2019 -
Appeals court judge on ACA: 'Congress can fix this'
Two Republican-appointed judges hammered Democrats on whether the ACA's individual mandate was severable from the rest of the law and asked why Congress expected them to find a solution.
By Samantha Liss , Dana Elfin • July 10, 2019 -
Air ambulance industry on defense as surprise billing debate heats up
Emergency air service providers are warning of base closures if surprise billing legislation working its way through Congress passes.
By Samantha Liss • July 10, 2019 -
Trump executive order seeks to overhaul US kidney care
The government push for home dialysis will help major payers like UnitedHealth Group, Cigna, Anthem and Humana and interested companies like CVS Health move into the space.
By Rebecca Pifer • UPDATED: July 10, 2019 at 1:48 p.m. -
In win for pharma, Trump TV drug price rule struck down
The federal district court sided with a drugmaker coalition that argued the government overstepped its authority in trying to force price transparency in advertisements.
By Jonathan Gardner • July 09, 2019 -
Pharma stocks slide as industry mulls Trump drug price action
Drug pricing is back in the spotlight as politicians grapple with ways to bring down healthcare costs. While the meaning of the president's comments wasn't clear, Monday's market reaction was unambiguous.
By Ned Pagliarulo • July 09, 2019 -
Healthcare Dive's 10 biggest stories of the spring
From Amazon pushing into the prescription delivery sector to CVS-Aetna struggling to finalize their merger settlement agreement, read the top stories from the first half of the year.
By Rebecca Pifer • July 08, 2019 -
Air Methods, Global Medical Response most at risk with surprise billing ban
Large air ambulance companies have the most to lose should a ban on balance billing become law, a new report says.
By Ron Shinkman • July 08, 2019 -
Doctors significantly over-allocated times to perform joint replacements, study shows
Time periods estimated to perform medical procedures, known as relative value units, are crucial for determining how much surgeons and other doctors are paid for their work under the Medicare Physician Fee Schedule.
By Ron Shinkman • July 03, 2019 -
ACOs may need stronger financial incentives, like downside risk, to succeed
The proportion of ACOs taking downside risk has inched up in recent years but still represents a minority, a study published in Health Affairs found.
By Rebecca Pifer • July 03, 2019
