Plans shirking ACA rules could spur more out-of-network care

Allowing health coverage to be sold across state lines could also limit oversight, a report by state regulators said.

By Les Masterson • March 27, 2018

Aetna to offer point of sale pharmacy rebates to 3M customers

The insurer has opposed the CMS idea to mandate that Part D sponsors pass on a percentage of rebates to customers at the point of sale.  

By David Lim • March 27, 2018

CMS mum on restricting how payers use subsidies

Insurers that offer ACA plans often use the practice of "silver loading," which involves putting all the losses associated with the end of CSR payments on only silver plans.

By Les Masterson • March 26, 2018

Most employers short of tipping point for health coverage

The American Health Policy Institute predicted employers won't be rushing to drop health insurance as a benefit, but some will go that route in the face of unmanageable healthcare costs.

By Les Masterson • March 26, 2018

CMS proposes to reduce state Medicaid requirements for monitoring access

The proposed rule is part of the Trump administration's drive to cut administrative red tape.

By Meg Bryant • March 23, 2018

Centene fined $100K for not fixing provider network inadequacies

The Washington state insurance commissioner says the payer has not adhered to its compliance plan following a $1.5 million fine last December. 

By David Lim • March 23, 2018

ACA plan premium changes varied widely

Large premium hikes were connected to marketplace uncertainty, policy changes and payers dropping out of the exchanges, according to the Urban Institute.

By Les Masterson • March 22, 2018

Geisinger plans pilot to help patients get to appointments

Geisinger’s program will also provide transportation for non-clinical, but health-related reasons, such as going to counseling, a pharmacy, a grocery store or to a job interview.

By Les Masterson • March 22, 2018

White House report targets health insurer profitability

The Council of Economic Advisers report argues many insurance companies' net profit margins have returned to pre-ACA levels on the backs of taxpayers.

By David Lim • March 21, 2018

HHS makes case against hospitals' 340B suit in new filing

"Setting aside the final rule for 2018 would direct payments away from these other services while creating administrative havoc in the OPPS system," HHS argued in a court filing this week.

By David Lim • March 21, 2018

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