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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 -
Explore the Trendline➔
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TrendlineSurprise Billing
Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.
By Healthcare Dive staff -
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 -
Out-of-pocket healthcare costs up 11% in 2017
Highest out-of-pocket cost estimates were for orthopedics, plastic surgery, urology and neurology.
By Les Masterson • March 7, 2018 -
Insurers, hospitals slam Trump admin's association health plan proposal
America’s Health Insurance Plans argued the proposal could increase the risk of fraud and insolvency for consumers.
By David Lim • March 7, 2018 -
CMS floats $30M for QPP measures development
Areas for measure development include safety, care coordination, population health and prevention.
By Meg Bryant • March 6, 2018 -
State efforts to impose individual mandate going nowhere
Six states and Washington, D.C., have all proposed measures to bring back the individual mandate penalty for health insurance, but so far no legislature has done so.
By Les Masterson • March 6, 2018 -
HIMSS18: CMS chief touts EHR, PHR overhaul
Seema Verma said the agency is planning a "complete overhaul" of meaningful use standards for hospitals, but provided few details.
By Kim Dixon • March 6, 2018 -
Azar says HHS could intervene to 'uncomfortable degree' to achieve value
Speaking at an FAH conference, Azar emphasized giving consumers greater control over their health data and encouraged price transparency from both payers and providers.
By David Lim • March 6, 2018 -
Arkansas gets Medicaid work requirement
The state has not yet won approval for a part of the proposal to change the income requirement for Medicaid to 100% of the federal poverty level instead of 138% of FPL.
By Les Masterson • March 5, 2018 -
Patient safety ripe for investment, Frost & Sullivan says
The report predicted that adverse patient safety events in the U.S. and Western Europe will result in about $383.7 billion in healthcare costs over the next four years.
By Les Masterson • March 5, 2018 -
Medicaid can be key to tackling social determinants of health
Researchers said adding optional Medicaid benefits, integrating data systems and incorporating social determinants in screening and care delivery can help reduce disparities.
By Les Masterson • March 2, 2018 -
Deep Dive
Trump backs lawsuit against opioid companies
Bipartisan lawmakers are also working on a bill allowing more physicians to prescribe medication-assisted treatment and a restriction on prescriptions.
By David Lim • March 2, 2018 -
Deep Dive
4 questions on Uber's new healthcare platform
There are potentially billions in savings, but little real evidence exists so far.
By Jeff Byers , Shannon Muchmore • March 2, 2018 -
Network directory errors remain an issue, AMA report finds
Previously, CMS has spoken out about errors in provider directories of Medicare Advantage plans.
By Les Masterson • Feb. 28, 2018 -
Association health plans will up ACA market premiums, Avalere says
AHPs are a key part of the Trump administration’s plan to sidestep Affordable Care Act regulations.
By Les Masterson • Feb. 28, 2018 -
20 states suing to invalidate ACA
The Republican attorneys general are arguing that with the individual mandate penalty zeroed out, it can't be enforced and the law is unconstitutional.
By Shannon Muchmore • Feb. 28, 2018 -
CVS, Aetna unscathed through congressional hearing
The AMA is asking Congress to "closely scrutinize the pending merger deal" on worries it would reduce competition among PBMs, local health insurance markets and local retail pharmacy markets.
By David Lim • Feb. 28, 2018 -
Alphabet's Verily seeks collaboration with health insurers
CNBC reported the life sciences arm of Google is interested in assisting payers with population health management.
By Les Masterson • Feb. 28, 2018 -
Clinicians seek more time in risk-free ACO track
Of the 561 accountable care organizations currently in the Medicare Shared Savings Program, 82% are still in Track 1.
By Meg Bryant • Feb. 27, 2018 -
CMS study to shed light on MIPS burden
The study could lead to changes in data capture and reporting, the agency said.
By Meg Bryant • Feb. 27, 2018 -
Kentucky Medicaid to penalize patients for unneeded ED visits
The move is part of a larger plan to reshape Medicaid in Kentucky, most notably requiring able-bodied beneficiaries to work to be eligible for coverage.
By Les Masterson • Feb. 27, 2018
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