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

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. 7, 2018

Explore the Trendline➔

Payer/provider relationships

As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

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. 7, 2018

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. 6, 2018

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. 6, 2018

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. 5, 2018

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. 5, 2018

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. 4, 2018

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. 4, 2018

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. 4, 2018

The 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 • Dec. 3, 2018

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. 3, 2018

Payer 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. 3, 2018

Disruptor 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. 3, 2018

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

Number of uninsured children increases for first time in decade

The percentage of uninsured children in the U.S. went up from 4.7% in 2016 to 5% in 2017, and nine states saw "significant" increases, according to the Georgetown University Health Policy Institute.

By Les Masterson • Nov. 30, 2018

HHS outlines broad plan to reduce EHR burden

The 74-page draft strategy, required by the 21st Century Cures Act, focuses on reducing time and effort tied to regulatory reporting requirements and increasing functionality and user-friendliness of EHRs.

By Meg Bryant • Nov. 29, 2018

CMS offers states more waiver options to skirt ACA requirements

Administrator Seema Verma said the move will improve affordability and consumer choice, but Democratic Sen. Ron Wyden said the proposal will promote "junk plans."

By Les Masterson • Nov. 29, 2018

Advocacy groups push back against CMS protected drugs claims

A new study undermines the agency's claim that payers lack the tools to drive down costs for drugs in protected classes.

By Samantha Liss • Nov. 29, 2018

AMA report finds less payer competition

The states that saw the largest drops in competition between 2016 and 2017 were North Dakota, Alaska, Louisiana, Indiana and Utah, according to the study.

By Les Masterson • Nov. 28, 2018

CVS-Aetna megamerger finalized

The total value of the acquisition, including assumption of Aetna's debt, clocks in at $78 billion. The union creates the second biggest private company by revenue after Walmart.

By Rebecca Pifer • Nov. 28, 2018

States debate Medicaid work requirements in wake of midterms

Virginia is the latest state to apply for a waiver, but Wisconsin's governor-elect is contemplating an end to his state's work requirement.

By Les Masterson • Nov. 28, 2018

Almost 70% of voters support protection for pre-existing conditions

More than 90% of self-identified Democrats, 79% of independents and 62% of Republicans would feel very concerned if they lost coverage for pre-existing conditions, according to the advocacy arm of the American Cancer Society.

By Rebecca Pifer • Nov. 28, 2018

UnitedHealth Group expects revenues to top $240B next year

At an investor conference in New York on Tuesday, the nation's largest commercial insurer said it expects revenues to increase at least 7.5% in 2019.

By Samantha Liss • Nov. 28, 2018

CMS aims to tackle drug costs by giving payers more bargaining power

Under the agency's proposal, Part D plans would be allowed to exclude protected drugs from their formularies in certain instances. 

By Samantha Liss • Nov. 27, 2018