Payer: Page 101
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Mid-sized hospitals could recover $500K through finding dual-eligibles
Medicaid is a "significant source of untapped reimbursements," according to a new report from TransUnion Healthcare.
By Les Masterson • Feb. 13, 2019 -
Provider groups wary of major changes to HIPAA
In response to an HHS request for information, AHA, AMA and others urged maintaining the status quo when it comes to potential amendments to the privacy law to better accommodate for value-based payment models.
By Shannon Muchmore • Feb. 13, 2019 -
Elizabeth Regan/Healthcare Dive
Regeneron, Sanofi cut PCSK9 list price, matching earlier move by rival Amgen
The drugmakers will soon make Praluent available for 60% less than the cholesterol drug's original price, a rare move reflective of ongoing commercial challenges.
By Ned Pagliarulo • Feb. 13, 2019 -
Molina saw membership drop in 2018, but net income rose substantially
Analysts characterized the better-than-expected results as "eye-popping."
By Samantha Liss • Feb. 12, 2019 -
Prices — not use — drive higher healthcare costs, HCCI says
Inpatient utilization dropped, but higher prices increased inpatient spending by 10% between 2013 and 2017. Meanwhile, outpatient surgery prices and higher emergency room use and prices led to more outpatient costs.
By Les Masterson • Feb. 12, 2019 -
Hospitals should focus on productivity gains to reduce costs, report finds
From 2001 to 2016, the healthcare delivery industry grew 3.3% annually to $1.3 trillion — with 99% of growth fueled by labor costs, according to McKinsey & Company.
By Meg Bryant • Feb. 11, 2019 -
Republicans eye modest Medicaid expansion
The safety net program is growing in popularity, leaving some GOP politicians to juggle the pros and cons of expanding it to more low-income Americans.
By Les Masterson • Feb. 10, 2019 -
EDs could save $8.3B annually with better primary care, study finds
Of 24 million emergency visits by patients with certain chronic conditions in 2017, 4.3 million were potentially avoidable, according to a Premier analysis.
By Meg Bryant • Feb. 8, 2019 -
Lyft eyes bigger role in nonemergency medical transport, MA plans
The rideshare giant is upgrading its Concierge product and starting collaborations with Blue Cross Blue Shield Institute and LogistiCare to reach more Medicare Advantage members.
By Meg Bryant • Feb. 8, 2019 -
Deep Dive
Hospital lobby ramps up 'Medicare for all' opposition
As more Democratic presidential hopefuls embrace the idea, health systems and providers have picked up lobbying efforts arguing it would shutter hospitals.
By Tony Abraham • Feb. 8, 2019 -
Health information exchange participation reduced readmissions in heart attack patients, study finds
The Florida report suggests HIEs could be deployed to enhance quality measures in the Hospital Readmissions Reduction Program.
By Meg Bryant • Feb. 7, 2019 -
EHR vendor Greenway Health hit with $57.25M False Claims fine
In addition to misrepresenting the capabilities of its software, the company is accused of falsely obtaining 2014 Edition certification status for its Prime Suite EHR.
By Meg Bryant • Feb. 7, 2019 -
Judge denies Oscar injunction over exclusive broker policies in Florida
The startup insurer alleged that it failed to capture projected market share in the state because of brokers lost due to exclusive contracts enforced by its competitor — Blue Cross Blue Shield of Florida.
By Samantha Liss • Feb. 7, 2019 -
Deep Dive
With CMS depression device on the line, analysts eye multibillion potential market
The government insurer may cover a clinical trial of LivaNova's vagus nerve stimulation in some cases as a last resort for severe depression. At the same time, some patients are turning to less invasive tech-driven therapies.
By Maria Rachal • Feb. 7, 2019 -
Employer plans contributed most to growth in underinsured
Long-term uninsured rates have also dropped, from 72% of people going without coverage for more than two years in 2010 to 54% in 2018, according to a new report from The Commonwealth Fund.
By Shannon Muchmore • Feb. 7, 2019 -
Anthem members sue payer for inadequate notice of dropped providers
The insurance giant has agreed to delay considering Atlanta-based health system WellStar's primary care providers out-of-network until May after a request from the Georgia Department of Insurance.
By Les Masterson • Updated March 6, 2019 -
Docs say prior authorizations harm clinical outcomes
Nearly two-thirds of physicians said they wait at least one business day for prior authorization decisions from health plans, according to the report from the American Medical Association.
By Meg Bryant • Feb. 6, 2019 -
Humana rides MA wave, beats Q4 earnings expectations
The payer reported revenues of $14.17 billion for the year, compared to $13.9 billion in 2017. CFO Brian Kane attributed the growth to Medicare Advantage membership, which grew by more than 9%.
By Tony Abraham • Feb. 6, 2019 -
In hiking prices, drugmakers show some signs of tempering increases
Analysts at Raymond James found pharma price increases last month to be somewhat smaller than in January 2018 — evidence, perhaps, of some newfound restraint.
By Andrew Dunn • Feb. 6, 2019 -
Consumers aren't using health savings accounts for long-term savings strategy, study finds
Spending HSA funds on regular care leaves consumers at risk of paying out-of-pocket costs for emergencies and hospital visits, according to the report from Lively, Inc.
By Les Masterson • Feb. 6, 2019 -
AHA roadmap to rescue rural hospitals calls for regulatory relief, new payment models
Other priorities include updating Medicare and Medicaid payment rates to cover costs of care and expanding access to telehealth, according to a new report from the hospital group.
By Meg Bryant • Feb. 5, 2019 -
Anthem's PBM will trail nation's largest as it looks to compete sooner
Even though Anthem is the nation's second-largest insurer, its PBM IngenioRx will have a considerably smaller footprint out of the gate.
By Samantha Liss • Feb. 5, 2019 -
Hospital prices, not physicians, drive cost growth, Health Affairs says
The report suggests measures aimed at cutting healthcare costs focus on issues like antitrust enforcement and incentivizing more cost-efficient physician referrals.
By Shannon Muchmore • Updated Feb. 5, 2019 -
Centene's ACA exchange business boosts earnings
The payer raised its guidance Tuesday, expecting revenue for the year to be between $70.3 billion and $71.1 billion.
By Samantha Liss • Feb. 5, 2019 -
Sponsored by Veradigm
Next focus for DaVinci – clinical data exchange
The DaVinci project is working to improve clinical data exchange between health plans and providers.
By Stephen Dean, General Manager, Health Plan Solutions, Veradigm • Feb. 5, 2019
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