Payer
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Fitbit rolls out connected health platform for health plans, employers
The tool leverages the company's wearables technology with Twine Health's disease management know-how.
By Meg Bryant • Sept. 20, 2018
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Lack of consistent process hinders data sharing among HHS agencies, report finds
Issues include lack of processes and accountability for data sharing, as well as resource constraints.
By Meg Bryant • Sept. 20, 2018
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Change Healthcare deploys blockchain network on Amazon Web Services
The cloud-based network will let providers and payers track claims submissions and payments in real time.
By Meg Bryant • Sept. 20, 2018
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Prescriptions, ED visits, outpatient services drive healthcare spending growth
The Health Care Cost Institute found that employer-sponsored insurance spending increased by 44% between 2007 and 2016.
By Les Masterson • Sept. 20, 2018
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Senators take aim at surprise billing
A draft bill from a bipartisan group would ban balance billing and require that insurers, rather than patients, pay out-of-network providers at 125% of the average in-network rate.
By Tony Abraham • Sept. 19, 2018
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Medicare ACOs save more money with more time, Avalere says
The Medicare Shared Savings Program has been scrutinized recently as more performance data surface. After the initiative missed federal cost savings projections from 2013 to 2016, recent results have been more promising.
By Les Masterson • Sept. 19, 2018
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Deep DiveWhy payers are gobbling up PBMs
On Monday the Justice Department gave its blessing to a $67 billion acquisition of Express Scripts by Cigna.
By Samantha Liss • Sept. 18, 2018
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CMS proposes streamlining some Medicare compliance rules
If finalized, the rule would remove the requirement that ambulatory surgical centers have a written transfer agreement with a hospital or that the center's physicians have admitting privileges at a nearby hospital.
By Tony Abraham • Sept. 18, 2018
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NQF report focuses on rural-relevant quality measures
The National Quality Forum's Measure Applications Partnership workgroup looked for measures that are cross-cutting, resistant to low case volume and drive access to care.
By Meg Bryant • Sept. 18, 2018
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Challenge to short-term plans joins chorus of ACA lawsuits
While the outcome of a lawsuit threatening the landmark law is pending in Texas, patient advocates in Washington, D.C., and the Maryland attorney general are suing to protect the act.
By Les Masterson • Sept. 17, 2018
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Cigna-Express Scripts merger cleared by DOJ
Federal regulators said the deal "is unlikely to result in harm to competition or consumers." Eyes now turn to the proposed Aetna-CVS union.
By Samantha Liss • Sept. 17, 2018
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Patient attribution crucial part of value-based contracting, actuaries say
There are trade-offs between attribution methods that rely on retrospective reviews of fee-for-service claims and those that attribute patients in advance of performance periods, according to a Society of Actuaries report.
By Les Masterson • Sept. 17, 2018
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Hospitals, telehealth providers prepare for Hurricane Florence
As with last year's Hurricanes Harvey and Irma, hospital operators in Florence's path could take a financial hit. HCA, Tenet, Community Health Systems and LifePoint Health could all see volumes dip.
By Meg Bryant • Sept. 14, 2018
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Payer trade group highlights need for housing programs
Housing is one of the most complex social determinants of health, and insurers have partnered with other health organizations to invest in affordable real estate and expand case management services, according to AHIP.
By Les Masterson • Sept. 14, 2018
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Evolent buys New Century Health to beef up specialty care
The value-based care services company is looking to expand its influence over costs and move into Medicare Advantage, a high-growth area.
By Les Masterson • Sept. 13, 2018
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Managed care companies, providers would benefit from Medicaid expansion
Four states with ballot initiatives this fall to expand Medicaid could boost bottom lines of big-name payers and health systems, according to a new report.
By Les Masterson • Sept. 12, 2018
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California law brings more scrutiny of payer mergers
Payers must get approval from the state for any transaction that affects a "significant number of enrollees," "involves a material amount of assets" or adversely affects "the stability of the health care delivery system."
By Les Masterson • Sept. 12, 2018
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Michigan threatens to repeal Medicaid expansion if work requirements not approved
Two JAMA studies bolster critics of work requirements who say most Medicaid recipients who are able to work are already doing so, and tracking compliance will heap more administrative burden onto an already-taxed system.
By Rebecca Pifer • Sept. 12, 2018
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In big payer win, court sides with UnitedHealth on MA overpayment rule
A federal judge vacated the rule, which the insurers said created additional burdens for Medicare Advantage plans not consistent with traditional Medicare regulations.
By Les Masterson • Sept. 10, 2018
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Modest ACA plan premium changes expected for 2019
Following a year of concern about hefty rate increases and the possibility of some counties not having any ACA plan options, 2019 is shaping up to be a stable year for the exchanges.
By Les Masterson • Sept. 10, 2018
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Montana co-op wins $5.3M CSR lawsuit
The judge ruled that the federal government didn't fulfill its obligation under the ACA when it stopped the cost-sharing reduction payments last year.
By Les Masterson • Sept. 07, 2018
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Physician-led ACOs saw savings in Medicare program
Hospital-integrated ACOs, however, didn't have the same success, according to a study published in the New England Journal of Medicine.
By Les Masterson • Sept. 06, 2018
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Premiums rise when hospitals buy doctor practices, study finds
The study in Health Affairs also found prices were likely to rise for outpatient visits as private practices were acquired or vertically integrated with hospital systems.
By Samantha Liss • Sept. 06, 2018
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More patients sidestepping ED for low-acuity problems
Despite growing use of lower-cost care options, spending for low-acuity conditions rose 14% between 2008 and 2015, according to a report published in JAMA Internal Medicine.
By Meg Bryant • Sept. 06, 2018
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JAMA studies show upsides of CMS bundled payment models
The reports found reduced institutional post-acute discharges with the CJR program and no increase in patient volume for the BPCI model.
By Les Masterson • Sept. 06, 2018