3 payment methods that could reduce diagnostic errors

A new Health Affairs study looks at potential coding changes in the Physician Fee Schedule, diagnostic-focused alternative payments models and a confirmation mechanism for APM recipients.

By Tony Abraham • Nov. 7, 2018

Execs bullish on IT, home health, M&A for 2019

More than 70% of executives predict better performance in the next 12 months, according to a Capital One survey. About 42% forecast increased deal activity.

By Meg Bryant • Nov. 6, 2018

North Carolina proposes setting hospital payments for state employees on Medicare rates

Hospitals elsewhere are likely to watch the plan closely, worried it could set a precedent. The move comes as providers are pushing back against CMS price cut proposals and on the defensive against complaints about high costs.

By Meg Bryant • Nov. 6, 2018

Kaiser reports 9% Q3 revenue growth, membership boost

The integrated health system said a new accounting standard was behind a 32% year-over-year drop in net income.

By Les Masterson • Nov. 6, 2018

Healthcare startups raise $26B in 2018, eclipsing prior years

Venture capital funding through October surpassed the total raised in 2012 and 2013 combined, according to a Pitchbook analysis for Forbes.

By Meg Bryant • Nov. 5, 2018

Judge shuts down Florida payer for selling plans FTC calls 'worthless'

Simple Health Plans misled people into thinking they were buying comprehensive health insurance, according to the Federal Trade Commission.

By Les Masterson • Nov. 5, 2018

Land O'Lakes calls itself first to offer new association health plans

The Trump administration has encouraged AHPs to spur cheaper health insurance options, but critics call out flexibility for plans to offer skimpier protections.

By Les Masterson • Nov. 5, 2018

Shareholder sues over 'doomed' Anthem-Cigna transaction

The suit claims the merger faced an "insurmountable barrier" because of Anthem's intention to sideline Cigna if a deal was reached.

By Samantha Liss • Nov. 5, 2018

Medicare Advantage audits could save $4.5 billion over a decade, CMS says

America’s Health Insurance Plans questions the audits and how they could affect health insurers and beneficiaries. 

By Les Masterson • Nov. 2, 2018

Samsam ransomware continues to target hospitals

Of 67 SamSam attacks this year, roughly one-fourth involved healthcare organizations, according to cybersecurity firm Symantec.

By Meg Bryant • Nov. 1, 2018

Cigna revenue boosted by commercial growth, now eyes Medicare Advantage

The CEO pointed to potential headwinds for 2019, including individual market revenues not as strong as this year.

By Les Masterson • Nov. 1, 2018

It's not just providers. Payers, too, have wide gap in prices, report finds

The priciest payer in Massachusetts costs about 13% more on average than the cheapest major payer, the National Bureau of Economic Research found. 

By Les Masterson • Oct. 31, 2018

A timeline of Anthem's bold payment policies (and the fallout)

The payer's aggressive moves to push procedures like imaging to outpatient settings and taking a hard line on emergency room visits has drawn fire from doctors and other critics.​

By Samantha Liss • Oct. 31, 2018

Anthem grows Medicare business as overall membership dips

The Indianapolis-based payer saw membership slide in its individual, local group and Medicaid businesses during the third quarter but was buoyed by significant gains in its Medicare lives.

By Samantha Liss • Oct. 31, 2018

Aetna reports slight revenue bump, membership decrease ahead of acquisition

The payer said it had a 3% increase in total revenue over the previous year to $15.5 billion in the third quarter and a 19% increase in net income to $1 billion.

By Les Masterson • Oct. 30, 2018

MA plans could use more telehealth services under proposed rule

The proposal would also revise star ratings methodology and improve CMS efforts to recover improper payments.

By Les Masterson • Oct. 29, 2018

Look out device makers — Amazon to sell glucose monitors, blood pressure cuffs

The products will be sold under the brand name Choice through a partnership with Arcadia Group, a consultancy firm with a history of partnering with big brand retailers like Walmart.

By Samantha Liss • Oct. 29, 2018

ACA premiums would be lower if not for GOP efforts, report finds

Premiums in unsubsidized exchange plans will be 6% higher next year than if Congress and the White House didn't implement policy changes like zeroing out the individual mandate penalty, according the Kaiser Family Foundation.

By Les Masterson • Oct. 29, 2018

Anthem hires former Google search chief to lead AI efforts

Udi Manber's resume includes stints at Amazon, Yahoo and a Bay Area NIH research and development center.

By Meg Bryant • Oct. 26, 2018

Healthcare M&A drops in volume, value for Q3, PwC says

This quarter saw the fewest number of deals since the beginning of 2017. Long-term care remained the most active sub-sector with 102 deals.

By Les Masterson • Oct. 26, 2018

Status quo or blue wave? How the midterms could hit healthcare companies

Election Day is here, and who voters send to Congress will have implications throughout the healthcare industry. Here's a reminder of the various scenarios.

By Samantha Liss • Oct. 25, 2018

Employers doing little about healthcare waste, report finds

Though 57% of employers believe that up to a quarter of healthcare dollars are wasted, most don't collect or analyze data to track waste, according to the National Alliance of Healthcare Purchaser Coalitions.

By Les Masterson • Oct. 25, 2018

Trump signs opioids bill as GAO says government can do more

Also this week, CMS rolled out a payment model to improve care coordination for mothers with opioid use disorders.

By Meg Bryant • Oct. 25, 2018

More evidence shows doctors leery of risk in payment models

Research from RAND and the AMA showed a widespread perception that alternative payment models are changing more quickly and becoming increasingly complex, creating new challenges for practices that use them.

By Meg Bryant • Oct. 24, 2018

Medicaid enrollment down amid increase in managed care, report finds

Reasons for the decline include no new states expanding Medicaid over the past year, a strong economy and that the program "appears to have reached a natural ceiling," according to A2 Strategy Group.

By Les Masterson • Oct. 24, 2018