Payer
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CMS touts dip in Medicare Advantage premiums for 2021
SVB Leerink analysts point to Centene, Humana and UnitedHealthcare as payers best positioned to pick up more share next year.
By Samantha Liss • Sept. 25, 2020 -
Sturti via Getty Images
Sponsored by GeneiaIt's high time payers opened the digital front door
A digital front door helps health plans to improve member satisfaction, quality outcomes and costs.
By Heather Staples Lavoie, President and CEO, Geneia • Sept. 25, 2020 -
Trendline
Social determinants of health
The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.
By Healthcare Dive staff -
Opinion
Medicare Advantage should not 'game the system' but prioritize patient care, honest billing
The HHS Office of Inspector General's principal deputy warns, "My office and other government agencies are targeting oversight to make sure plans do not pad risk adjustments with unsupported diagnoses."
By Christi A. Grimm • Sept. 23, 2020 -
Payers, other stakeholders urge Congress to blunt COVID-19-spurred insurance losses
"The odds are we are on track to having the greatest coverage losses we've ever recorded," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, said during a briefing Tuesday.
By Samantha Liss • Sept. 23, 2020 -
Adobe Stock
Centene sues drugmaker Indivior over 'profit protection scheme'
The payer is seeking to recoup money it paid for opioid addiction medicines that should have had generic equivalents — or cheaper alternatives. It alleged the drug company devised a plan to box out competitors.
By Samantha Liss • UPDATED: Sept. 23, 2020 at 11:47 a.m. -
CMS to expand ambulance prior authorization model nationwide
The model saved Medicare about $650 million in four years without changing care quality or access. However, the timeline for its rollout is still to be determined amid COVID-19 uncertainty.
By Rebecca Pifer • Sept. 23, 2020 -
'We feel bullish': Payers look ahead to 2021
Top execs at the biggest commercial insurers outlined shifting strategic priorities and growth opportunities in light of the COVID-19 recession at Morgan Stanley's annual healthcare conference last week.
By Rebecca Pifer • Sept. 17, 2020 -
CMS innovation agency to launch risk-based model for dual eligibles
Along with the dual-eligible demonstration, CMMI head Brad Smith said Tuesday industry could expect some additional models to come out of the pipeline in the next few months.
By Rebecca Pifer • Sept. 16, 2020 -
In deal with Apple, CVS clients get temporary access to new fitness feature
CVS CEO Larry Merlo also gave an update at Morgan Stanley's annual healthcare conference on its conversion of retail locations to HealthHUBs.
By Rebecca Pifer • Sept. 16, 2020 -
Uninsured rate rose to 9.2% in US last year, pre-COVID-19 recession
The high cost of U.S. healthcare continues to stress the country's economic outlook overall. About 7.7 million more Americans would be considered low-income if their medical bills were factored in, the U.S. Census Bureau said.
By Rebecca Pifer • Sept. 16, 2020 -
Permission granted by Cigna
Cigna rebrands health services division, including Express Scripts, as Evernorth
The move is an evolution for the Cigna-Express Scripts tie-up completed in late 2018, as the combined entity looks to spur more interest in its products from third parties.
By Rebecca Pifer • Sept. 16, 2020 -
Brian Tucker / Healthcare Dive
ACOs in Medicare Shared Savings Program post third year of savings
But the National Association of Accountable Care Organizations said only 5% of eligible ACOs took CMS’ offer on the Pathways to Success program structure early and instead chose to remain under the previous rules.
By Hailey Mensik • Sept. 15, 2020 -
Samantha Liss for Healthcare Dive
Centene added 1.1M members since March amid COVID-19 job losses
The payer also announced a partnership with Samsung to give 13,000 smartphones to patients in rural and underserved areas to help increase access to virtual care.
By Rebecca Pifer • Sept. 15, 2020 -
CMS to ax inpatient data in MA risk scoring by 2022
The proposed changes should be a net positive for Medicare Advantage players, resulting in a 0.25% rise in risk scores.
By Rebecca Pifer • Sept. 15, 2020 -
Getty Images
CMS kills controversial Medicaid fiscal accountability rule
The rule proposed last year would have increased federal oversight of how states fund their Medicaid programs and potentially resulted in funding cuts for the cash-strapped program. Providers strongly opposed it.
By Rebecca Pifer • Sept. 14, 2020 -
Samantha Liss for Healthcare Dive
Centene adds ACA offerings in 400 new counties, 2 new states for 2021
Despite the challenges and uncertainty brought on by the pandemic, the payer with the largest presence in the exchanges will now be in New Mexico and Michigan as well.
By Samantha Liss • Sept. 11, 2020 -
Fotolia
Employers struggling to calculate 2021 medical cost trends due to COVID-19: Credit Suisse
A survey run by the financial services firm found 60% of employers are trying to adjust 2020 claims data to normalize for the pandemic's effects while calculating expected medical cost trend next year.
By Rebecca Pifer • Sept. 11, 2020 -
A quarter of adults in employer plans are underinsured, Commonwealth Fund says
Despite having employer-sponsored coverage, many workers are inadequately insured and have problems paying their medical bills, which could be exacerbated during the public health crisis, according to the survey.
By Samantha Liss • Sept. 09, 2020 -
Cigna expanding footprint in ACA exchanges for 2021
The Connecticut-based payer is offering plans in 80 new counties for the 2021 plan year, increasing its marketplace presence by 27%.
By Rebecca Pifer • Sept. 09, 2020 -
Getty Images
Doctors affiliated with health systems have much higher MIPS scores, JAMA study finds
A separate study found that physicians who had the highest proportion of patients dually eligible for Medicare and Medicaid also had significantly lower performance scores than other doctors.
By Shannon Muchmore • Sept. 08, 2020 -
The White House/Healthcare Dive, data from WhiteHouse.gov
Federal COVID-19 cash saved most hospitals from bleakest forecasts: MedPAC
But any new congressional relief is stalled in Congress, and an HCA official warned cost-cutting initiatives that helped operators aren't sustainable.
By Rebecca Pifer • Sept. 04, 2020 -
Fotolia
CBO finds COVID-19 puts Medicare trust fund insolvency just 4 years away
The pandemic has shaved two years off the expected lifespan of the hospital insurance fund, leading Medicare experts to urge Congress to act as soon as possible to save the program.
By Rebecca Pifer • Sept. 04, 2020 -
[Photograph]. Retrieved from Regional Health Command Atlantic.
Telehealth claims dipped second month in a row in June: Fair Health
Though virtual care use remains extremely high compared to 2019, claim lines fell 21% from May to June as states began to allow in-person care once again.
By Rebecca Pifer • Sept. 03, 2020 -
Brian Tucker / Healthcare Dive
Final inpatient payment rule confirms price transparency push
CMS is also adding 24 technologies to receive add-on payments and finalizing a diagnosis-related group for CAR-T cancer therapies.
By Hailey Mensik • UPDATED: Sept. 3, 2020 at 9:14 a.m. -
CMS pitches coverage of breakthrough devices in tandem with FDA authorization
The proposal follows years of AdvaMed lobbying for products awarded the special FDA designation to gain Medicare reimbursement upon clearance or approval.
By Maria Rachal , Susan Kelly • Sept. 02, 2020
