Payer: Page 100
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Paying patients to shop yields modest savings, Health Affairs study finds
Price reductions were mostly seen in imaging services, especially MRI and ultrasound.
By Meg Bryant • March 5, 2019 -
Medicare for all (or some), buy in and other universal plans vary widely
Democratic presidential candidates like Sens. Kamala Harris and Bernie Sanders support a single-payer system. Sen. Amy Klobuchar backs a more modest Medicaid buy-in proposal.
By Les Masterson • March 5, 2019 -
US kidney care getting revamp, HHS officials say
Stocks of multiple dialysis providers plummeted Monday as Trump administration health chiefs previewed changes to kidney care payment models and transplant procedures.
By Rebecca Pifer Parduhn • March 4, 2019 -
Cost major influence in choosing medical care, survey shows
Despite that concern and rising out-of-pocket costs, more than two-thirds of adults don't seek cost estimates before getting care, a VisitPay survey found.
By Meg Bryant • Feb. 28, 2019 -
Courtesy of Sanofi
Sanofi handed payers nearly $12B in drug rebates last year
That's why, despite increasing the U.S. list price on 35 of its 76 prescription drugs, the French pharma reported an average net price decline of 8% in 2018.
By Ned Pagliarulo • Feb. 27, 2019 -
ACA plans denied nearly 1 in 5 in-network claims in 2017
Fewer than 1% of those denials were appealed, according to an analysis from the Kaiser Family Foundation.
By Les Masterson • Feb. 27, 2019 -
Doctor On Demand rolls out virtual care platform for primary care
The telehealth vendor is targeting its Synapse platform at health plans and employers.
By Meg Bryant • Feb. 26, 2019 -
Partial Medicaid expansion would increase uninsured rate, federal costs
A few states that haven't expanded the program under the ACA, including Utah and Georgia, are looking at partial expansion plans in an attempt to cut costs.
By Les Masterson • Feb. 22, 2019 -
UPMC fires back at state AG, seeks to join BCBS antitrust lawsuit
The flurry of filings taps into big questions over payer competition and underscores tensions between insurance companies and providers as they negotiate contracts, especially in highly concentrated markets.
By Tony Abraham , Samantha Liss • Updated March 19, 2019 -
Hospitals oppose fixed payments in any laws tackling surprise billing
Meanwhile, a new analysis shows that about one in five emergency department visits involve an out-of-network provider and could result in a surprise bill.
By Shannon Muchmore • Feb. 21, 2019 -
US healthcare spending growth to hit 5.5% by 2027, CMS predicts
The ballooning American healthcare bill will outstrip growth of the GDP over the next decade, according to an annual government report.
By Rebecca Pifer Parduhn • Feb. 20, 2019 -
Seniors love Medicare, but are pessimistic about its long-term future
One-third of responders to eHealth's Medicare Consumer Survey said when choosing a plan, an affordable monthly premium is the most important consideration.
By Les Masterson • Feb. 20, 2019 -
CMS unveils CAR-T proposal, with emphasis on patient outcomes
High price tags and a potential one-time administration have challenged CMS to figure out reimbursement for CAR-T cell therapies.
By Jacob Bell • Feb. 20, 2019 -
CVS 2019 guidance disappoints amid major headwinds
In its first earnings since bringing Aetna into the fold, the drugstore chain cited pressures having a "disproportionate impact" on the year, including issues with its long-term care business.
By Samantha Liss • Feb. 20, 2019 -
Insurers owed CSR payments regardless of silver loading, judges rule
In one of the lawsuits, a judge wrote the payer "should not be left 'holding the bag' for taking our Government at its word."
By Shannon Muchmore • Feb. 19, 2019 -
DOJ sticking with CVS-Aetna merger pact despite negative public comments
The agreement, which required Aetna to divest all of its Medicare Part D business, "fully addresses the competitive threat posed by the merger," the department said.
By Samantha Liss • Feb. 19, 2019 -
CMS emergency transport model supports telehealth, non-hospital venues
The five-year demonstration project — scheduled to kick off early next year — also encourages the creation of medical triage lines for low-acuity 911 calls.
By Meg Bryant • Feb. 15, 2019 -
Charitable enough? UPMC case highlights increased scrutiny of nonprofit hospitals
"I think the bottom line is: The AG is not going to be satisfied with a duopoly in which one firm is clearly dominant and is going to be able to have its way," said Tim Greaney, former assistant chief in the DOJ's antitrust division.
By Tony Abraham , Samantha Liss • Feb. 15, 2019 -
Partners-CNE deal won't get thorough review in Massachusetts
The state's health policy commission reported Partners' acquisition of Care New England will not affect competition or set back care access because of the health systems' different patient populations and geographies.
By Les Masterson • Feb. 15, 2019 -
HIMSS19: Lyft looks at nutrition amid population health focus
The strategy would expand the car-hailing firm's focus on addressing social determinants of health.
By Rebecca Pifer Parduhn • Feb. 15, 2019 -
Deep Dive
4 main takeaways from HIMSS19
Digest the biggest health IT conference of the year with this roundup of what grabbed the attention of more than 43,000 health execs, policymakers and academics.
By David Lim , Rebecca Pifer Parduhn • Feb. 15, 2019 -
Accrediting group updates widely used quality metrics
Medicare Advantage plans use NCQA quality metrics to measure the performance within their provider networks, any changes to those measures will be closely watched as MA plans now cover 22.4 million seniors.
By Meg Bryant • Feb. 14, 2019 -
Payers divided over best value-based payment model, survey finds
The new HealthEdge survey found that more than half of respondents believe provider and member engagement are the biggest obstacles to implementing value-based contracts.
By Les Masterson • Feb. 14, 2019 -
Data breaches compromised 15.1M patient records last year
The number of affected records was up sharply from the year before, when nearly 500 breaches affected 5.6 million records, according to Protenus.
By Meg Bryant • Feb. 13, 2019 -
HIMSS19: CVS, Cigna execs tout pharmacies amid pricing debate
The PBM leaders made the pitch they are well-placed to help drive down costs, given patients interact far more often with pharmacists than other healthcare providers.
By Rebecca Pifer Parduhn • Feb. 13, 2019
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