Payer
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CMS pitches new MA and Part D voluntary payment models
The MA model will test new service delivery approaches, including telehealth expansion, while the Part D model aims to control catastrophic drug spending by front-loading insurers with higher risk.
By Rebecca Pifer • Jan. 18, 2019
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eTransactions saw usage upswing in 2018: report
Findings from the Council for Affordable Quality Healthcare show real momentum for electronic administrative transactions, a crucial step toward reducing physician burnout and increasing workplace efficiency.
By Meg Bryant • Jan. 18, 2019
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CVS, Walmart resolve spat over pharmacy benefit pricing
The pact comes days after the two heavyweights said they'd hit a stalemate in contract negotiations.
By Kim Dixon • Jan. 18, 2019
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CMS cuts ACA exchange fees, floats proposal to end silver-loading
While no regulations limiting or banning auto-enrollment and silver-loading are contained in the rule, the agency has requested public comment on the two issues for consideration in future rules before 2021.
By Tony Abraham • Jan. 18, 2019
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More seniors may soon be sporting Apple Watches with MA partnerships
Tapping into the Medicare market could be lucrative for Apple and a good business strategy for insurers, given the aging U.S. population and rising healthcare costs.
By Meg Bryant • Jan. 17, 2019
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Appeals court upholds ruling against UnitedHealth in out-of-network billing case
The lawsuit involved the practice of cross-plan offsetting, wherein insurers recoup one plan's overpayment to out-of-network providers by reducing another plan's payment to the same provider.
By Meg Bryant • Jan. 17, 2019
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No single solution to patient matching challenge, GAO says
Questions about the accuracy of digital matching tools force providers to recheck results manually, according to the government watchdog.
By Meg Bryant • Jan. 16, 2019
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Massachusetts will ask Medicaid patients to rate their doctors
Nearly 250,000 beneficiaries will receive questions about primary care, mental health treatment and long-term care services in what the state says is a first-of-its-kind project.
By Les Masterson • Jan. 16, 2019
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Study shows impact of urgent care centers on nonemergent ED usage
The effect was limited to areas with multiple urgent care centers and privately insured patients, according to the National Bureau of Economic Research.
By Meg Bryant • Jan. 15, 2019
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CVS chief says industry disruption should come from within
During an address in D.C. on Monday, the pharmacy chain's CEO Larry Merlo touched on challenges facing the industry and announced a five-year $100 million commitment to bolster healthcare resources in local communities.
By Shannon Muchmore • Jan. 15, 2019
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Tenet renews ties with Humana, Anthem
After years of a rocky relationship, Humana members will have in-network access to Tenet's hospitals, outpatient centers and physician groups. Anthem BC members will also have access to Tenet's providers in California.
By Tony Abraham • UPDATED: Jan. 16, 2019 at 9:42 a.m.
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Optum drives UnitedHealth Group's Q4, yearly earnings increases
The payer's health services arm, known for driving vertical integration at the nation's largest commercial insurer, surpassed $100 billion in revenue for the first time in 2018.
By Les Masterson • Jan. 15, 2019
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Deep DivePayer, provider trends to watch in 2019
This year the industry will reckon with some massive changes set in motion in 2018, such as megamergers like CVS-Aetna and a judge's contentious declaration that the Affordable Care Act is no longer constitutional.
By Tony Abraham , Samantha Liss • Jan. 14, 2019
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Judge orders DOJ to continue CVS-Aetna review despite government shutdown
Delaying the case indefinitely because of the ongoing shutdown could have "far-reaching consequences" on consumers, D.C. District Court Judge Richard Leon wrote in his order Friday.
By Samantha Liss • Jan. 14, 2019
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Louisiana launching 'Netflix model' in Medicaid for hepatitis C drugs
The state is looking for a pharmaceutical partner on the project that will cap state spending on expensive treatments for the disease.
By Les Masterson • Jan. 14, 2019
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About 1 in 5 healthcare payments is tied to value-based model
Participation in major clinical registries is growing on average 7% annually, according to the new paper on quality initiatives and resource needs. Tracking quality measures through registries is a critical step to value-based payments.
By Meg Bryant • Jan. 11, 2019
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ONC to Congress: Room for improvement in data sharing
Ongoing barriers to seamless data sharing range from technical and financial to trust and business practices, according to the HHS IT department's latest progress report.
By Meg Bryant • Jan. 10, 2019
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Few digital health companies studying impact in high-burden populations, study finds
Only 16 of the more than 100 studies the authors looked at assessed a digital health product's impact on outcomes, and none measured its effect on cost or access to care, according to the report in Health Affairs.
By Meg Bryant • Jan. 10, 2019
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Government shutdown poses another hiccup for CVS-Aetna
CVS CEO Larry Merlo addressed the ongoing court review of the Aetna merger at J.P. Morgan's annual conference, saying it will not impede expected benefits from the marriage.
By Samantha Liss • Jan. 10, 2019
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Deep DiveHow AI could shape the health tech landscape in 2019
Highlights include technologies that seek to cut costs and promote patient health, especially in the areas of imaging, diagnostics, predictive analytics and administration.
By Rebecca Pifer • Jan. 10, 2019
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Grassley to zoom in on drug pricing, insurance mergers as Senate panel chair
The new Republican chairman of the Senate Finance Committee pledged to scrutinize mergers such as the CVS-Aetna deal and work to allow cheaper drug imports from Canada.
By David Lim • Jan. 10, 2019
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SponsoredEven without the final stamp of approval, CVS/Aetna can start preparing for the work that lies ahead
3 ways the CVS/Aetna merger can make healthcare consumers happier.
By Peter Manoogian
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Medicare joint replacement program could succeed in more regions, Health Affairs study says
The mandatory bundled payment model first implemented in 2016 has shown some ability to cut spending without negatively affecting care quality.
By Les Masterson • Jan. 09, 2019
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JPM19: Bluebird proposes installment plan for LentiGlobin gene therapy
The biotech company would receive further payments only if LentiGlobin keeps working, according to a theoretical payment scheme the company rolled out Tuesday.
By Kristin Jensen
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High-cost Medicare patients more likely to be younger, low-income
One of the greatest predictors of a high-cost patient was whether they are dually eligible due to chronic kidney disease.
By Samantha Liss • Jan. 09, 2019