Walgreens, Humana in talks to deepen partnership, WSJ reports

The two are reportedly considering taking equity stakes in the other. The news comes as payers rush to bulk up and differentiate themselves as disruptors like Amazon closely eye the sector.

By Samantha Liss • Nov. 21, 2018

CMS should give states more info to improve Medicaid MCO data reliability, GAO says

Of the eight states studied, three use an additional oversight practice to compare encounter data with an external data source and five use other mechanisms to enforce reporting requirements, including penalties, according to the watchdog.

By Les Masterson • Nov. 21, 2018

Telehealth laws inhibit widespread use in Medicare population, CMS says

The agency is opening up virtual care in some alternative payment models, but use among fee-for-service beneficiaries is just 0.25%, according to a new report. The states with the highest use are Texas, Iowa and California.

By Meg Bryant • Nov. 19, 2018

Lack of competition leads to higher ACA plan premiums in rural areas

Lower premiums in urban areas are partially related to more competition among plans and providers, according to a new report from the Urban Institute.

By Les Masterson • Nov. 19, 2018

Mitigating waste in healthcare/provider information exchanges

The data-driven environment has the opportunity to revolutionize healthcare/provider information exchanges.

Nov. 19, 2018

Blockchain application still in nascent stages for healthcare, report finds

Short-term applications for the technology include back office operations and product traceability, according to CB Insights.

By Meg Bryant • Nov. 16, 2018

Atrium Health agrees to stop anti-steering practices

The case involves a relatively new target for the Justice Department — restrictions imposed by providers to limit payers from moving patients to high-quality providers.

By Les Masterson • Nov. 16, 2018

CVS-Aetna merger cleared by California's insurance regulator

The state's reluctant nod came after the entity promised not to increase premiums as a result of acquisition costs. The deal now awaits regulatory approval from four more states and is expected to close by Thanksgiving.

By Rebecca Pifer Parduhn • Nov. 15, 2018

In rebound, ACA marketplace to offer more payer options in 2019

Despite concerns of more problems in 2018, ACA payers have actually found their footing — and are even enjoying profits now. Centene, Cigna, Oscar Health, Anthem and Wellmark are moving back into the market or expanding to more counties in 2019.

By Les Masterson • Nov. 15, 2018

Managed Medicaid plans treat chronic conditions on par with other commercial coverage, AHIP report finds

The payer group looked at data involving patients with asthma, diabetes and mood disorders to see how clinical care compared between Medicaid, commercial insurance and those who are uninsured.

By Les Masterson • Nov. 14, 2018

Express Scripts plans 'Flex' formulary focused on authorized generics

Gilead’s generic versions of its own hepatitis C treatments Epclusa and Harvoni are first on the list for the new formulary​, which starts Jan. 1.

By Kristin Jensen • Nov. 14, 2018

Specialty drugs drive Rx spending increase, Blue Cross says

Insurers under the Blues' umbrella spent about $100 billion on prescription drugs in 2017, making up roughly 20% of plans' overall healthcare spending. That figure is 2% higher than it was in 2016, and has consistently risen since 2010. 

By Andrew Dunn • Nov. 14, 2018

Oscar calls foul over BCBS' exclusive broker policy in Florida

The insurer filed suit against Florida's Blue plan, alleging anti-competitive conduct over broker's sales arrangements with BCBS.   

By Samantha Liss • Nov. 14, 2018

Nearly 50K would lose Medicaid under Arkansas work rules: study

Gresham v. Azar seeks to halt the work requirement experiment on grounds it runs counter to Medicaid law and risks the health of Arkansas' most vulnerable citizens.

By Meg Bryant • Nov. 14, 2018

Humana, Kaiser Permanente top customer satisfaction index

"Health insurance is complicated and controversial, making it by far the most problematic and least satisfying category in the sector," said David VanAmburg, managing director at the American Customer Satisfaction Index.

By Les Masterson • Nov. 13, 2018

CMS finds Strong Start birth centers save money, improve outcomes

Rates of preteen birth, unhealthy birthweight and cesarean section were all lower among birth center participants — as were costs.

By Les Masterson • Nov. 12, 2018

Post midterm win, Medicaid backers eye expansion in more red states

Victories in three states are inspiring backers in Missouri, Mississippi and Oklahoma who found themselves boxed out by Republican lawmakers unwilling to extend health coverage to more low-socioeconomic status residents. 

By Samantha Liss • Nov. 12, 2018

Retail clinics, employer activists poised to disrupt healthcare, report finds

Roughly one-fifth of consumers visited a retail clinic in the past several years, a new PwC study shows.

By Meg Bryant • Nov. 9, 2018

HHS teases mandatory bundled models in about-face

If such methods are needed to deliver change, HHS Secretary Alex Azar said Thursday, "mandatory models are going to see a comeback."

By Rebecca Pifer Parduhn • Nov. 9, 2018

Medicaid managed care proposal would tweak network adequacy standards

The proposed rule from CMS aims to create flexibility by removing "outdated" requirements that govern how plans communicate with beneficiaries and barriers to transitioning new services and populations into managed care.

By Tony Abraham • Nov. 9, 2018

Price, usage drive variations between regions' healthcare costs, report finds

Of six regions studied, Maryland had the lowest costs at 20% below the benchmark. On the other end, Colorado was 19% above the standard and Minnesota was 11% higher.

By Les Masterson • Nov. 9, 2018

CMS to scrutinize premium subsidy eligibility, expands contraception exemptions

The agency said the proposed rule is focused on making sure taxpayer dollars are spent appropriately, but did not offer any details on whether exchange subsidy eligibility has been a problem in the past.

By Samantha Liss • Nov. 8, 2018

Signups lag in first days of ACA open enrollment

It's still early in the process, but enrollment will need to pick up significantly over the next month to approach last year's numbers, according to CMS data.

By Les Masterson • Nov. 8, 2018

ACA, hospitals win as health focus helps Dems flip House

Democrats will be able to swat down any attempts at repealing the Affordable Care Act, but it's unlikely Congress will stitch together repair efforts for the ACA, either, analysts warn.

By Samantha Liss • Nov. 7, 2018

Medicare Advantage drives Humana's Q3 revenue growth

However, the payer said MA and TRICARE gains were partially offset by Part D, Medicaid and commercial enrollment losses.

By Les Masterson • Nov. 7, 2018