Government: Page 109
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Providence St. Joseph launches for-profit population health management company
The new company, called Ayin, will provide capabilities like a pharmacy benefits management program that partners pharmacists and physicians in a coordinated care model and a risk evaluation tool.
By Les Masterson • Feb. 5, 2019 -
Hospital prices, not physicians, drive cost growth, Health Affairs says
The report suggests measures aimed at cutting healthcare costs focus on issues like antitrust enforcement and incentivizing more cost-efficient physician referrals.
By Shannon Muchmore • Updated Feb. 5, 2019 -
Judge tosses Maryland lawsuit seeking to shield ACA
Meanwhile, four more states are seeking to join an appeal defending the Affordable Care Act after a Texas judge declared it unconstitutional in December.
By Meg Bryant • Feb. 4, 2019 -
Deep Dive
Clinical lab lobbying spikes as PAMA cuts kick into effect
Paralleling CMS payment cuts that took effect at the start of last year, lobbying by Quest Diagnostics, LabCorp and the American Clinical Laboratory Association jumped to $4.4 million, up from $2.5 million in 2017.
By David Lim • Feb. 4, 2019 -
Opinion
Changing how we pay for healthcare to promote high-quality care, eliminate waste
The fee-for-service model needs an overhaul to best serve patients, argue Suzanne Delbanco, Maclaine Lehan and Roslyn Murray of the nonprofit Catalyst for Payment Reform.
By Suzanne Delbanco, Maclaine Lehan, Roslyn Murray • Feb. 4, 2019 -
Payers balk at HHS proposal to end federal PBM rebates
America's Health Insurance Plans criticized the administration's decision as "well-intentioned but misguided." The payer lobby insisted that rebate savings go directly to consumers, saving them on premiums and cost-sharing.
By Shannon Muchmore • Feb. 1, 2019 -
States ill-equipped to oversee short-term plans
Officials worry consumers won't be fully informed about what they're purchasing after researching short-term plans, according to a study from the Georgetown University Center on Health Insurance Reforms.
By Meg Bryant • Feb. 1, 2019 -
Taylor McKnight/Healthcare Dive
California sees 24% dive in new ACA plan enrollments
State officials pinned the blame on loss of the federal tax penalty for people without health insurance, but CMS pushed back on that claim.
By Meg Bryant • Jan. 31, 2019 -
CMS proposes more nontraditional benefits for MA plans
If the policy changes are approved, the expected average increase in revenue for 2020 Medicare Advantage plans is 1.59%, down from the 3.4% increase for 2019.
By Shannon Muchmore • Jan. 31, 2019 -
New VA rules reignite privatization debate
VA Secretary Robert Wilkie preemptively dismissed critics, saying they "claim falsely and predictably" the new rules represent a "first step toward privatizing the department."
By Tony Abraham • Jan. 31, 2019 -
Narrow networks can effectively control health costs, report finds
But excluding hospitals in narrow plans may harm patients who live near those facilities, according to the American Economic Association paper.
By Les Masterson • Jan. 30, 2019 -
CMS launches app showing Medicare beneficiaries what their plans cover
The app's Blue Button 2.0 functionality also lets people connect claims information to tools that "help them understand, use and share their health data," the agency said.
By Les Masterson • Jan. 29, 2019 -
Deep Dive
Industry braces as more lawmakers seek to ban surprise billing
"Pretty much everybody agrees that the consumer shouldn't be trapped in the middle of these conversations — that's the easy part," said Jack Hoadley, research professor emeritus at the Georgetown University Health Policy Center.
By Shannon Muchmore • Jan. 29, 2019 -
Focus on usability, interoperability to help reduce health IT burden, groups tell ONC
Stakeholders also urged ONC to consider artificial intelligence tools as a means of relieving hassles from EHR use.
By Meg Bryant • Jan. 29, 2019 -
Integrate, bolster finances to break down silos in care, think tank suggests
The Bipartisan Policy Center also recommended increased federal spending and improved care coordination as methods for removing barriers between behavioral health and other services.
By Les Masterson • Jan. 28, 2019 -
Doctors less likely to accept Medicaid than other insurance
MACPAC found no difference in Medicaid acceptance between doctors in states that expanded the program under the ACA and those that didn't — except with OB-GYNs.
By Les Masterson • Jan. 28, 2019 -
JAMA study makes case for investing in primary care
People with primary care receive more high-value care, slightly more low-value care and report better healthcare experiences than those without primary care, according to a new study in JAMA Internal Medicine.
By Meg Bryant • Jan. 28, 2019 -
Medicaid advisory panel calls for phasing in DSH allotment reductions
The suggestions also include changes in how disproportionate share hospital spending is allocated, and are projected to save the government anywhere from $1 billion to $5 billion over the next decade.
By Rebecca Pifer Parduhn • Jan. 25, 2019 -
ACA exchanges showing stability after rocky years
More payers are offering Affordable Care Act plans and premium increases are relatively modest despite attempts from Washington to undermine the law, according to a report from the Urban Institute.
By Les Masterson • Jan. 25, 2019 -
How the shutdown is hitting healthcare: rural hospitals, public health, ACA credits
One potential problem is delayed processing of tax credits to help people pay for health insurance premiums in Affordable Care Act exchange plans.
By Les Masterson • Jan. 24, 2019 -
Number of uninsured adults reaches post-ACA high
The uninsured rate reached a four-year high at nearly 14% in the fourth quarter of last year, according to a new Gallup poll.
By Tony Abraham , Samantha Liss • Jan. 23, 2019 -
Downside risk spurs provider exodus in bundled payment models, GAO says
The watchdog also found provider groups participating in any of the six bundled payment models from CMS had larger practices and higher care episode volume on average, and were more likely to be located in urban areas.
By Rebecca Pifer Parduhn • Jan. 23, 2019 -
CMS approves 8th state for Medicaid work requirement
Arizona's policy is expected to begin in 2020 and affect about 120,000 residents.
By Les Masterson • Jan. 22, 2019 -
CMS pitches new MA and Part D voluntary payment models
The MA model will test new service delivery approaches, including telehealth expansion, while the Part D model aims to control catastrophic drug spending by front-loading insurers with higher risk.
By Rebecca Pifer Parduhn • Jan. 18, 2019 -
Opioid marketing leads to more prescriptions, deaths, says JAMA study
More marketing interactions with physicians led to more prescriptions.
By Les Masterson • Jan. 18, 2019
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