Payer
-
Payer participation in ACA exchanges lacks in parts of US
In the Northeast, 40% of the population lives in an area with at least five ACA plan payers. That figure is only 4% in the South, according to the Urban Institute.
By Les Masterson • March 22, 2019 -
GAO finds 'small number' of payers dominate private, ACA markets
The three largest payers in most states owned 80% or more of the private market in 2016, with even more concentration in state ACA exchanges up to 2017, the watchdog agency said.
By Tony Abraham • March 22, 2019 -
MIPS participation in year 1 nets 95% of eligible clinicians
Of those participating in the Merit-based Incentive Payment System in 2017, 93% earned a positive payment adjustment, according to a new CMS report.
By Meg Bryant • March 21, 2019 -
Nearly 70% of air ambulance transports in 2017 put patients at risk of balance bills, GAO says
Air ambulance providers and insurers admit the share of out-of-network transports are high, but said they've recently entered into more in-network deals.
By Samantha Liss • March 21, 2019 -
OpinionOscar Health: a rebel brand without a cause
Daniel Black from brand strategy consultancy Vivaldi on why 7-year-old payer Oscar Health is all flash and little substance.
By Daniel Black • March 21, 2019 -
Sage's postpartum depression drug is approved. Now comes the hard part
Zulresso's label requires women to undergo a 60-hour infusion and only in certain settings, factors that may hamper the drug commercially.
By Jacob Bell • UPDATED: March 20, 2019 at 9:12 a.m. -
Specialty drug costs skyrocketed to $32.8B in Medicare Part D in 2015
Brand-name specialty drugs accounted for only 1% of all prescriptions dispensed in both Medicare Part D and Medicaid, but made up about 30% of net spend.
By Rebecca Pifer • March 20, 2019 -
Electronic prior authorization merits wider adoption, health IT, payer groups say
New data show the practice led to faster turnaround times and higher dispense rates than traditional requests by phone or fax.
By Rebecca Pifer • March 20, 2019 -
Managing high-cost claims tops employer benefit plan concerns
Companies are also offering their workers more perks like telehealth, according to a new Mercer cost trends survey.
By Meg Bryant • March 19, 2019 -
Payers, employers pitch fixed reimbursement rates for out-of-network providers to curb surprise billing
Hospital groups quickly slammed the proposal as "a dangerous precedent" that could "create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks."
By Les Masterson • March 19, 2019 -
Physician-led ACOs leaving Medicare program in greater numbers
The vast majority of ACOs have stayed with the Medicare Shared Savings Program, however, with only 13% of them dropping out last year.
By Les Masterson • March 18, 2019 -
Direct enrollment for ACA plans may lead to higher costs, fewer protections
The Center on Budget and Policy Priorities warned that direct enrollment through entities other than HealthCare.gov or state exchange websites stifles competition and can confuse and mislead consumers.
By Les Masterson • March 18, 2019 -
Healthcare execs worried about business model disruption, survey shows
Risk aversion, integrating social determinants of health and rising consumerism are also catching the attention of C-suites in 2019, according to a new survey commissioned by Change Healthcare and the HealthCare Executive Group.
By Meg Bryant • March 18, 2019 -
Short-term plans, Medicaid waivers, MA benefits dominate AHIP conferences
A House panel is investigating short-term "junk plans" and payers look to take advantage of more flexible benefit options in Medicare Advantage. That (and more) from AHIP's dual conferences last week.
By Shannon Muchmore , Rebecca Pifer • March 18, 2019 -
Amazon-Berkshire-JPM's Haven hires clinical strategy leader
Sandhya Rao joins the splashy venture from Partners Population Health, where she was senior medical director.
By Meg Bryant • March 15, 2019 -
Medicaid work requirements will hurt hospital finances
Meanwhile, this week Trump administration officials argued in defense of the work requirements in front a skeptical federal judge who already halted the regulation in Kentucky.
By Les Masterson • March 15, 2019 -
Telehealth underused by federally qualified health centers, analysis finds
Centers use telehealth largely for behavioral health sessions with patients, though some store-and-forward activities and remote patient monitoring also occur, according to the report by RAND Corporation.
By Meg Bryant • March 14, 2019 -
State-run reinsurance programs helped lower ACA plan premiums by 20%
The seven states using reinsurance have saved the federal government almost $1 billion, according to a new report from Avalere.
By Les Masterson • March 14, 2019 -
Blues challenge UPMC, call Highmark contract dispute 'of its own making'
The Blue Cross Blue Shield Association argued it's too late for UPMC to intervene in a years-long litigation challenging the way Blues plans operate.
By Samantha Liss • UPDATED: March 15, 2019 at 11:07 a.m. -
PBMs called to give patients 'an explanation' by Senate panel
Cigna, CVS Caremark and CVS Health, Humana, UnitedHealth's OptumRx and Prime Therapeutics got invites to the latest Senate Finance Committee hearing. The panel said two of the companies have so far agreed to testify.
By Shannon Muchmore • UPDATED: March 19, 2019 at 4:02 p.m. -
AMA says prior authorizations increasing, interfering with care continuity
A new survey of 1,000 physicians found that more than two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization.
By Les Masterson • March 13, 2019 -
Cambia, BCBS of North Carolina link to form $16B insurer
The entity will remain under the Cambia name and be helmed by current Blue Cross North Carolina head Patrick Conway, who formerly led the Center for Medicare and Medicaid Innovation.
By Rebecca Pifer • March 13, 2019 -
House panel to launch investigation into short-term 'junk' plans
The Committee on Energy and Commerce will probe companies offering the short-term coverage and "hold them accountable," said Chairman Frank Pallone, D-N.J., including those run by UnitedHealth and Anthem.
By Rebecca Pifer • March 13, 2019 -
HHS hints at cutting 'onerous' substance abuse record rules
Deputy Secretary Eric Hargan told attendees at AHIP's National Health Policy Conference to "watch this space very carefully" for changes to the law known as Part 2.
By Rebecca Pifer • March 13, 2019 -
Hospital groups say public option would cut payments by 10%
The American Hospital Association and Federation of American Hospitals argue an opt-in government insurance plan would hit bottom lines and disrupt the insurance market.
By Tony Abraham • March 13, 2019
