Payer

CMS emergency transport model supports telehealth, non-hospital venues

The five-year demonstration project — scheduled to kick off early next year — also encourages the creation of medical triage lines for low-acuity 911 calls.

By Meg Bryant • Feb. 15, 2019

Charitable enough? UPMC case highlights increased scrutiny of nonprofit hospitals

"I think the bottom line is: The AG is not going to be satisfied with a duopoly in which one firm is clearly dominant and is going to be able to have its way," said Tim Greaney, former assistant chief in the DOJ's antitrust division.

By Tony Abraham , Samantha Liss • Feb. 15, 2019

Partners-CNE deal won't get thorough review in Massachusetts

The state's health policy commission reported Partners' acquisition of Care New England will not affect competition or set back care access because of the health systems' different patient populations and geographies.

By Les Masterson • Feb. 15, 2019

HIMSS19: Lyft could move into food delivery as part of population health focus

The strategy would expand the car-hailing firm's focus on addressing social determinants of health from just transportation to include combating food deserts and nutritional deficiencies.

By Rebecca Pifer • Feb. 15, 2019

Accrediting group updates widely used quality metrics

Medicare Advantage plans use NCQA quality metrics to measure the performance within their provider networks, any changes to those measures will be closely watched as MA plans now cover 22.4 million seniors.

By Meg Bryant • Feb. 14, 2019

Payers divided over best value-based payment model, survey finds

The new HealthEdge survey found that more than half of respondents believe provider and member engagement are the biggest obstacles to implementing value-based contracts.

By Les Masterson • Feb. 14, 2019

Data breaches compromised 15.1M patient records last year

The number of affected records was up sharply from the year before, when nearly 500 breaches affected 5.6 million records, according to Protenus.

By Meg Bryant • Feb. 13, 2019

HIMSS19: CVS, Cigna execs tout pharmacies amid pricing debate

The PBM leaders made the pitch they are well-placed to help drive down costs, given patients interact far more often with pharmacists than other healthcare providers.

By Rebecca Pifer • Feb. 13, 2019

Mid-sized hospitals could recover $500K through finding dual-eligibles

Medicaid is a "significant source of untapped reimbursements," according to a new report from TransUnion Healthcare.

By Les Masterson • Feb. 13, 2019

Provider groups wary of major changes to HIPAA

In response to an HHS request for information, AHA, AMA and others urged maintaining the status quo when it comes to potential amendments to the privacy law to better accommodate for value-based payment models.

By Shannon Muchmore • Feb. 13, 2019

Regeneron, Sanofi cut PCSK9 list price, matching earlier move by rival Amgen

The drugmakers will soon make Praluent available for 60% less than the cholesterol drug's original price, a rare move reflective of ongoing commercial challenges. 

By Ned Pagliarulo • Feb. 13, 2019

Molina saw membership drop in 2018, but net income rose substantially

Analysts characterized the better-than-expected results as "eye-popping."

By Samantha Liss • Feb. 12, 2019

Prices — not use — drive higher healthcare costs, HCCI says

Inpatient utilization dropped, but higher prices increased inpatient spending by 10% between 2013 and 2017. Meanwhile, outpatient surgery prices and higher emergency room use and prices led to more outpatient costs.

By Les Masterson • Feb. 12, 2019

Hospitals should focus on productivity gains to reduce costs, report finds

From 2001 to 2016, the healthcare delivery industry grew 3.3% annually to $1.3 trillion — with 99% of growth fueled by labor costs, according to McKinsey & Company.

By Meg Bryant • Feb. 11, 2019

Republicans eye modest Medicaid expansion

The safety net program is growing in popularity, leaving some GOP politicians to juggle the pros and cons of expanding it to more low-income Americans.

By Les Masterson • Feb. 10, 2019

EDs could save $8.3B annually with better primary care, study finds

Of 24 million emergency visits by patients with certain chronic conditions in 2017, 4.3 million were potentially avoidable, according to a Premier analysis.

By Meg Bryant • Feb. 08, 2019

Lyft eyes bigger role in nonemergency medical transport, MA plans

The rideshare giant is upgrading its Concierge product and starting collaborations with Blue Cross Blue Shield Institute and LogistiCare to reach more Medicare Advantage members.

By Meg Bryant • Feb. 08, 2019

Health information exchange participation reduced readmissions in heart attack patients, study finds

The Florida report suggests HIEs could be deployed to enhance quality measures in the Hospital Readmissions Reduction Program.

By Meg Bryant • Feb. 07, 2019

EHR vendor Greenway Health hit with $57.25M False Claims fine

In addition to misrepresenting the capabilities of its software, the company is accused of falsely obtaining 2014 Edition certification status for its Prime Suite EHR.

By Meg Bryant • Feb. 07, 2019

Judge denies Oscar injunction over exclusive broker policies in Florida

The startup insurer alleged that it failed to capture projected market share in the state because of brokers lost due to exclusive contracts enforced by its competitor — Blue Cross Blue Shield of Florida.

By Samantha Liss • Feb. 07, 2019

Employer plans contributed most to growth in underinsured

Long-term uninsured rates have also dropped, from 72% of people going without coverage for more than two years in 2010 to 54% in 2018, according to a new report from The Commonwealth Fund.

By Shannon Muchmore • Feb. 07, 2019

Anthem members sue payer for inadequate notice of dropped providers

The insurance giant has agreed to delay considering Atlanta-based health system WellStar's primary care providers out-of-network until May after a request from the Georgia Department of Insurance.

By Les Masterson • Feb. 07, 2019