More evidence shows doctors leery of risk in payment models

Research from RAND and the AMA showed a widespread perception that alternative payment models are changing more quickly and becoming increasingly complex, creating new challenges for practices that use them.

By Meg Bryant • Oct. 24, 2018

Amgen cuts US Repatha price 60% amid market pressure

While effective, the cholesterol drug's $14,520 list price has been a tough pill to swallow for payers. On Wednesday, Amgen said it would lower that price to $5,850.

By Jacob Bell • Oct. 24, 2018

Medicaid enrollment down amid increase in managed care, report finds

Reasons for the decline include no new states expanding Medicaid over the past year, a strong economy and that the program "appears to have reached a natural ceiling," according to A2 Strategy Group.

By Les Masterson • Oct. 24, 2018

Risky business: 5 provider strategies to take on downside risk

"Over time, regulations change," Heritage Provider Network CEO Richard Merkin said. "You have to adjust. If you embrace the status quo, you're dead."

By Rebecca Pifer Parduhn • Oct. 24, 2018

Loss of pre-existing condition protections would hit 100M, Avalere says

The analysis comes as the Trump administration props up skimpy health plan options and backs a Texas lawsuit seeking to repeal the ACA.

By Samantha Liss • Oct. 24, 2018

APM adoption up to 34%, but downside risk slow to catch on

Organizations truly committed to value-based payment need to be willing to put their money where their mouth is, Seth Morris, director of network development at Anthem, said at a summit announcing the findings of a new report.

By Rebecca Pifer Parduhn • Oct. 23, 2018

Viagra no more: The changing face of drug ads on TV

Gone are twin bathtubs and little blue pills. Instead, pharma promotions on TV are more likely to feature complex biologics and cancer drugs. 

By Ned Pagliarulo • Oct. 23, 2018

Burnout hurts nurses' ability to meet profession's demands

Because nurses usually have frequent direct interactions with patients, burnout may pose a risk to "patient and organizational outcomes," according to a new white paper from Press Ganey.

By Les Masterson • Oct. 23, 2018

CEO Matt Eyles on why AHIP will probably have to change its name

The insurer lobby's leader addresses key issues affecting the industry and the group's evolving role as insurers morph into both provider and payer.

By Samantha Liss • Oct. 23, 2018

Critics pounce as CMS gives states more leeway to skirt ACA

New guidance on 1332 Medicaid waivers makes it easier for states to use association and short-term health plans that limit coverage for pre-existing conditions.

By Tony Abraham • Oct. 23, 2018

Hospital execs admit lack of readiness for Ebola in 2014, but defenses improving

Most said they could adequately respond to such an emergency now, but acknowledge they were not ready to handle Ebola cases during the outbreak, according to a report from the HHS Office of Inspector General.

By Les Masterson • Oct. 22, 2018

CVS-Aetna merger hits snag in New York, clears Connecticut

New York financial regulators want assurances the companies won't raise premiums in the state.

By Meg Bryant • Oct. 22, 2018

At least 40% of Medicare Advantage plans to offer pop health benefits

Avalere analyzed CMS data on MA coverage for newly allowed benefits including bathroom safety devices, over-the-counter meds and transportation assistance.  

By Les Masterson • Oct. 22, 2018

Doubt cast on value of hospital accreditation in Harvard study

"Given the minimal benefit seen with accreditation in this study, it raises the question of whether our national efforts need to emphasize accreditation as much as they do," researchers said.

By Meg Bryant • Oct. 19, 2018

Study finds 40% of doctors pessimistic about practice of medicine

This unease includes concern about their practice's financial stability and administrative management, as well as use of EHRs, according to a new Leavitt Partners white paper.

By Les Masterson • Oct. 19, 2018

Stakeholders call for transparency, ease of use in EHR Reporting Program

In comments, several healthcare organizations requested a centralized clearinghouse of existing health IT comparison resources.

By Meg Bryant • Oct. 18, 2018

Industry on Medicare ACO plan: too much risk too fast

Some providers warn they'll drop out if CMS finalizes its proposal as is. Others contend the agency is cracking down on the program in an attempt to kill it.

By Tony Abraham • Oct. 18, 2018

Medicaid expansion doesn't impede care access or cause longer wait times, study finds

A new National Bureau of Economic Research working paper found no change in office visits, number of days between visits, expenditures and wait times after Medicaid expansion.

By Les Masterson • Oct. 18, 2018

Insurers see broad market opportunities with end-of-life care

"The reimbursement rates are strong and it's a profitable service to be delivering," said Avalere's Dan Mendelson. "Whenever you have that kind of situation you're going to also have speculative buying and desire to grow these markets."

By Rebecca Pifer Parduhn • Oct. 17, 2018

#AHIPMMD speakers mull role of government regulation in healthcare

As payers gathered at AHIP's annual conference on Medicare, Medicaid and dual eligibles, hot topics included the promises of Medicare Advantage, the role of the federal government and drug prices.

By Samantha Liss • Oct. 17, 2018

5 questions on the Trump admin's bid to mandate prices in drug ads

The proposal is expected to face fierce opposition from industry and raises a wide range of legal, political and economic questions.

By Ned Pagliarulo , Andrew Dunn • Oct. 17, 2018

#AHIPMMD: Verma touts MA growth, blasts Medicare for all

So far, 270 Medicare Advantage plans will offer new benefits allowed for 2019 that include adult day care and meals, the CMS administrator said at the annual payer conference.

By Samantha Liss • Oct. 17, 2018

GAO study underscores health benefits of Medicaid expansion

Voters in four states will decide on expansion initiatives in the midterm elections next month.

By Meg Bryant • Oct. 16, 2018

CVS CEO unfazed by Amazon, focused on closing merger, growth

In a speech to the Economic Club of Washington, Larry Merlo said his goal is to not "leave any white space for Amazon to disrupt."

By Rebecca Pifer Parduhn • Oct. 16, 2018

Anthem shells out $16M in largest ever HIPAA fine

The settlement will pay for four years of credit monitoring and all other claims, costs and fees for affected members.

By Rebecca Pifer Parduhn • Oct. 16, 2018