Payer: Page 103
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ACA exchanges showing stability after rocky years
More payers are offering Affordable Care Act plans and premium increases are relatively modest despite attempts from Washington to undermine the law, according to a report from the Urban Institute.
By Les Masterson • Jan. 25, 2019 -
Fitbit targets newest activity trackers at health, wellness plans
Fitbit Inspire and Inspire HR are available solely through the company's corporate partners and affiliates.
By Meg Bryant • Jan. 24, 2019 -
Double-digit growth in hip, knee replacements driving healthcare spending
A new analysis shows a growing proportion of Blue Cross Blue Shield members are electing to undergo the orthopaedic procedures.
By Nick Paul Taylor • Jan. 24, 2019 -
Hospital groups push shared infrastructure, rules of road to boost interoperability
Data sharing barriers include lack of standard vocabulary between health IT platforms and changing regulatory requirements and timelines, the American Hospital Association and six other groups said in a report.
By Meg Bryant • Jan. 23, 2019 -
Walgreens pays $270M to settle Medicaid fraud allegations
For years, the U.S. government alleges, the pharmacy giant routinely submitted false data to improperly secure federal reimbursement for insulin pens not needed by patients.
By Suzanne Elvidge • Jan. 23, 2019 -
Number of uninsured adults reaches post-ACA high
The uninsured rate reached a four-year high at nearly 14% in the fourth quarter of last year, according to a new Gallup poll.
By Tony Abraham , Samantha Liss • Jan. 23, 2019 -
Downside risk spurs provider exodus in bundled payment models, GAO says
The watchdog also found provider groups participating in any of the six bundled payment models from CMS had larger practices and higher care episode volume on average, and were more likely to be located in urban areas.
By Rebecca Pifer Parduhn • Jan. 23, 2019 -
CMS approves 8th state for Medicaid work requirement
Arizona's policy is expected to begin in 2020 and affect about 120,000 residents.
By Les Masterson • Jan. 22, 2019 -
Private equity boost, upskilling workers among 2019 sector trends, PwC reports
With the average health insurance deductible triple what it was a decade ago, the consultancy believes 2019 could also be the year for value line products and services — similar to the Southwest Airlines approach.
By Meg Bryant • Jan. 18, 2019 -
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 Parduhn • Jan. 18, 2019 -
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 -
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 -
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 -
Retrieved from Apple on March 10, 2015
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 -
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 -
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 -
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 -
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 -
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 -
Getty / Edited by Healthcare Dive
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 -
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 -
Deep Dive
Payer, 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 -
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 -
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 -
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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