Blues plans made money in individual market last year

Payers still face an uncertain 2018 and 2019 in the ACA exchanges.  

By Les Masterson • March 20, 2018

Big Data is the 'new gold rush,' report predicts

Among companies making a play in data analytics is Alphabet's life sciences arm Verily.

By Meg Bryant • March 20, 2018

Maryland's all-payer model saved Medicare millions in first 3 years

A review of the state program found that it's on track to meet CMS-imposed targets for savings and patient safety.  

By Les Masterson • March 19, 2018

Hospital prices see biggest gain in years, hiring on upswing

Hospital prices grew at their highest rate since 2009. Overall healthcare costs saw the highest increase since 2012.  

By Les Masterson • March 19, 2018

CMS finalizes coverage of DNA sequencing for cancer patients

The agency will cover similar tests approved by the FDA.

By Jeff Byers • March 19, 2018

Trump to pitch national PDMP to fight opioid crisis

The president will visit New Hampshire to announce a slate of proposals, including calling for legislation to allow Medicaid to reimburse residential treatment at facilities with more than 16 beds.

By David Lim • March 19, 2018

CMS plans MACRA changes to ease burden

CMS is expected to add more alternative payment models and is hoping to automatically receive quality data from EHRs rather than physicians reporting the data.  

By Les Masterson • March 19, 2018

AMA survey says prior authorizations hurting clinical outcomes

Nearly one-third of physicians said they needed to wait at least three business days for a prior authorization decision, and doctors say the payer requests are rising.  

By Les Masterson • March 19, 2018

ACA stabilization bills may become part of spending package

The Congressional Budget Office said resurrecting CSR payments could reduce premiums and increase the number of insured Americans.  

By Les Masterson • March 16, 2018

CMS star ratings biased towards specialty hospitals, analysis suggests

Specialty hospitals reported fewer measures than major teaching hospitals, and frequently omitted mortality data.

By Meg Bryant • March 16, 2018

Female doctors earn 28% less than men, report finds

Doximity found doctors saw a 4% wage increase from 2016 to 2017, but a persistent wage gap is widening.

By Les Masterson • March 15, 2018

340B accountability under fire at Senate panel

The hearing comes as drugmakers point fingers at hospitals and other players involved in the drug pricing system.

By David Lim • March 15, 2018

BCBS joins with Lyft, CVS and Walgreens in new pop health effort

The payer is looking to address "transportation and pharmacy deserts" in test markets.

By Les Masterson • March 15, 2018

Centene partnering with PBM RxAdvance

The announcement comes as other payers, such as Cigna and Aetna, are looking to make major moves in the PBM space.  

By Les Masterson • March 14, 2018

AHIP's CEO Tavenner to retire

The organization's chief operating officer, Matt Eyles, will be next to lead the lobby group.

By David Lim • March 14, 2018

Right to Try fails amid warning from regulators, patient groups

Backers of the bill, like President Trump and the Koch brothers, faced off against major patient groups and some regulators.

By David Lim • March 14, 2018

HDHPs can be more cost-effective for consumers, report says

A new National Bureau of Economic Research working paper looked at how much people could save over a year by going with high-deductible health plans.  

By Les Masterson • March 14, 2018

Labor, administrative costs drive US healthcare spending far beyond other nations

The report found the U.S. pays more for healthcare than other high-income countries, but has the lowest percentage of insured people, the lowest life expectancy and the highest infant mortality rate.

By Les Masterson • March 13, 2018

Drug spending growth to come solely from specialty meds, report says

Developed markets will shell out more than $300 billion for the often complex, expensive treatments this year, according to new estimates from IQVIA.

By Jacob Bell • March 13, 2018

Restoring CSR funds with no reforms may do more harm

The individual market endured an end to cost-sharing reduction payments, but reviving them without more changes could threaten stability, a new report said.  

By Les Masterson • March 12, 2018

GOP actions may spur huge ACA premium hikes

Premiums could skyrocket by more than 90% in some states over the next three years, according to a report by Covered California.

By Les Masterson • March 12, 2018

Medicare Advantage risk-adjustment proposal causes alarm

The American Hospital Association and other groups are concerned about the plan to use more patient encounter data when calculating risk scores.

By Les Masterson • March 9, 2018

CMS denies Idaho bid to sell plans not compliant with ACA

Agency head Seema Verma said that despite the denial, the state could meaningfully implement many of the same goals legally through short-term, limited-duration plans. 

By David Lim • March 9, 2018

UnitedHealth Group plans more scrutiny of ED claims

The payer will review emergency claims with the most serious conditions and reduce or deny any incorrect claims it finds.

By Les Masterson • March 8, 2018

Gottlieb takes aim at payers, pharmas for blocking biosimilars

The FDA chief lambasted PBMs, insurers and branded drugmakers for allegedly blocking market entry of the copycat biologics.

By Lisa LaMotta , David Lim • March 8, 2018