Payer
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California, New York OK Cigna-Express Scripts deal with conditions
The megamerger now waits on one more state — New Jersey — for final approval.
By Samantha Liss • Dec. 14, 2018
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Fitch says payer sector stable, buoyed by MA rate increase, robust economy
There are debt issues related to M&A and concerns about the ACA exchanges over the next year, according to the ratings agency.
By Les Masterson • Dec. 14, 2018
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DOJ takes up lawsuit accusing Sutter Health of cheating Medicare
The whistleblower lawsuit alleges the California health system and an affiliate manipulated diagnosis codes to inflate payments.
By Meg Bryant • Dec. 13, 2018
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ACO trade group says Medicare program saved $859M in 2016
The program, which includes 561 accountable care organizations and 10.5 million patients, saved more than $660 million between 2013 and 2016 after bonuses paid to providers for meeting spending and quality targets.
By Les Masterson • Dec. 13, 2018
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PwC: 'New Health Economy' finding its feet, but challenges remain
Providers are embracing digital treatments, with 77% saying they have suggested an app or digital program to a patient, according to the industry trends report.
By Meg Bryant • Dec. 12, 2018
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1 in 5 patients at high risk of socioeconomic health problem, survey finds
Patients who discuss their social determinant of health challenges with a clinician are more likely to accept help, according to the study. Younger patients, while twice as likely to discuss, are less receptive to assistance.
By Tony Abraham • Dec. 12, 2018
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4.2M Americans eligible for free ACA coverage, KFF says
In Iowa, Nebraska, Delaware and Utah alone, roughly half of potential marketplace shoppers could get a 2019 bronze plan with a $0 premium, according to the analysis.
By Rebecca Pifer • Dec. 12, 2018
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Envision, UnitedHealthcare settle fierce nationwide contract squabble
If the two giant for-profit companies hadn't reached a deal, 27 million privately insured Americans could have been slammed with surprise emergency room bills as early as January.
By Rebecca Pifer • Dec. 11, 2018
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SponsoredWhat payers and providers need to know about reverification season
As plans renew and sponsors move into more restricted networks, the likelihood that several patients will have to switch to a different pharmacy is very real.
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Payer, hospital groups trade blame on surprise billing
The problem of patients unexpectedly getting a bill for out-of-network services is common and growing, especially for people getting emergency room care.
By Les Masterson • Dec. 11, 2018
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CMS reinstates risk adjustment program for ACA exchanges
In February, a federal judge in New Mexico vacated the risk adjustment program, namely the statewide average premium in the HHS methodology.
By Les Masterson • Dec. 10, 2018
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Virtual visits led to uptick in overall visits at Massachusetts ACO, study shows
Participants tended to be younger, white and commercially insured, raising concerns that virtual visit programs could increase disparities in access to care.
By Meg Bryant • Dec. 07, 2018
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MedPAC pitches 2% boost in hospital Medicare payments, merged quality incentive program
The adviser to CMS and Congress on Medicare has been focused on the shift to value-based care in recent months. Its new linked proposals are no exception.
By Rebecca Pifer • Dec. 07, 2018
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OIG raises concerns about safety in long-term care hospitals
More than half of harmful events in LTCHs are preventable, according to a new report from the watchdog agency.
By Meg Bryant • Dec. 06, 2018
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Hospital docs weigh in on CAR-T reimbursement: 'It's very complicated'
Looming over clinical victories seen at the American Society of Hematology's annual conference was a problematic question: How exactly will health systems pay for these powerful yet pricey therapies?
By Jacob Bell • Dec. 06, 2018
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Aetna, Ascension join industry blockchain pilot to improve network directory data
Nearly half of Medicare Advantage directories contain at least one provider location error, according to CMS.
By Meg Bryant • Dec. 05, 2018
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Narrow networks remain common in ACA marketplace
HMOs remain the most typical type of plan in the market. Exclusive provider organizations are increasing, and will make up 19% of all available options in 2019.
By Les Masterson • Dec. 05, 2018
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Most in Hospital Value-Based Purchasing Program to get higher payments next year
The data suggest slight improvements in quality and value for the 2,800 hospitals that take part in the program, including better total performance scores. However, fewer facilities received incentive bonuses than last year.
By Tony Abraham • Dec. 04, 2018
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Not so fast: Judge delays CVS-Aetna closure, instructs companies to remain separate
The nearly $70 billion megamerger may not be a done deal after all. A judge has not yet signed off on the agreement between the DOJ and the two companies.
By Samantha Liss • Dec. 04, 2018
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Telehealth uptake surprisingly low among physicians, AMA finds
Large and specialty practices are more likely to use telehealth, suggesting that implementation costs are a barrier, according to a new study in Health Affairs.
By Meg Bryant • Dec. 04, 2018
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Dive AwardsThe Healthcare Dive Awards for 2018
The awards recognize the healthcare industry's top disruptors and innovators. These executives and companies are transforming the industry and shaping the future.
By Healthcare Dive Team
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HHS accepting comments on performance measure changes
The National Quality Forum's Measure Applications Partnership will make recommendations for changes to programs like MIPS by Feb. 1.
By Les Masterson • Dec. 03, 2018
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Dive AwardsPayer of the Year: Anthem
Frustrated with big unexplainable price differences among providers and what it calls unnecessary and costly emergency room visits, Anthem put in place a series of restraints on access to patients and physicians.
By Samantha Liss • Dec. 03, 2018
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Dive AwardsDisruptor of the Year: Amazon
Although some analysts remain skeptical about Amazon's threat to the highly regulated industry, the landscape looks entirely different than it did just one year ago.
By Samantha Liss • Dec. 03, 2018
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Fitch sees stable 2019 for US healthcare despite financial pressures
Expect 2018's two-to-one ratio of downgrades to upgrades to continue next year, the ratings agency said.
By Meg Bryant • Nov. 30, 2018