Risky business: 5 provider strategies to take on downside risk

"Over time, regulations change," Heritage Provider Network CEO Richard Merkin said. "You have to adjust. If you embrace the status quo, you're dead."

By Rebecca Pifer Parduhn • Oct. 24, 2018

Loss of pre-existing condition protections would hit 100M, Avalere says

The analysis comes as the Trump administration props up skimpy health plan options and backs a Texas lawsuit seeking to repeal the ACA.

By Samantha Liss • Oct. 24, 2018

APM adoption up to 34%, but downside risk slow to catch on

Organizations truly committed to value-based payment need to be willing to put their money where their mouth is, Seth Morris, director of network development at Anthem, said at a summit announcing the findings of a new report.

By Rebecca Pifer Parduhn • Oct. 23, 2018

CEO Matt Eyles on why AHIP will probably have to change its name

The insurer lobby's leader addresses key issues affecting the industry and the group's evolving role as insurers morph into both provider and payer.

By Samantha Liss • Oct. 23, 2018

Critics pounce as CMS gives states more leeway to skirt ACA

New guidance on 1332 Medicaid waivers makes it easier for states to use association and short-term health plans that limit coverage for pre-existing conditions.

By Tony Abraham • Oct. 23, 2018

Centene Q3 income down significantly, membership up

CEO Michael Neidorff said he's committed to continuing to increase the payer's Medicare Advantage business and predicts it will fuel growth over the next decade.

By Samantha Liss • Oct. 23, 2018

CVS-Aetna merger hits snag in New York, clears Connecticut

New York financial regulators want assurances the companies won't raise premiums in the state.

By Meg Bryant • Oct. 22, 2018

Anthem ER policy could deny 1 in 6 visits if universally adopted, JAMA study warns

The big Blues payer is sticking by its controversial emergency policy despite lawsuits and criticism.

By Tony Abraham • Oct. 22, 2018

At least 40% of Medicare Advantage plans to offer pop health benefits

Avalere analyzed CMS data on MA coverage for newly allowed benefits including bathroom safety devices, over-the-counter meds and transportation assistance.  

By Les Masterson • Oct. 22, 2018

Doubt cast on value of hospital accreditation in Harvard study

"Given the minimal benefit seen with accreditation in this study, it raises the question of whether our national efforts need to emphasize accreditation as much as they do," researchers said.

By Meg Bryant • Oct. 19, 2018

#AHIPMMD: Optum touts social determinants, Medicaid popularity up

Understanding a member and even their hierarchy in the family are tools to better predict healthcare use and spend, Optum's Jim Dolstad told AHIP conference attendees in D.C. this week.

By Samantha Liss • Oct. 19, 2018

Stakeholders call for transparency, ease of use in EHR Reporting Program

In comments, several healthcare organizations requested a centralized clearinghouse of existing health IT comparison resources.

By Meg Bryant • Oct. 18, 2018

UnitedHealth to launch 'fully integrated' EHR next year

Details are sparse on what exactly the payer's model will look like or how it might address the many pitfalls found in electronic systems today.

By Rebecca Pifer Parduhn • Oct. 18, 2018

Medicaid expansion doesn't impede care access or cause longer wait times, study finds

A new National Bureau of Economic Research working paper found no change in office visits, number of days between visits, expenditures and wait times after Medicaid expansion.

By Les Masterson • Oct. 18, 2018

Insurers see broad market opportunities with end-of-life care

"The reimbursement rates are strong and it's a profitable service to be delivering," said Avalere's Dan Mendelson. "Whenever you have that kind of situation you're going to also have speculative buying and desire to grow these markets."

By Rebecca Pifer Parduhn • Oct. 17, 2018

#AHIPMMD speakers mull role of government regulation in healthcare

As payers gathered at AHIP's annual conference on Medicare, Medicaid and dual eligibles, hot topics included the promises of Medicare Advantage, the role of the federal government and drug prices.

By Samantha Liss • Oct. 17, 2018

Leapfrog Group to start rating outpatient settings

The nonprofit will collect safety and quality data on ambulatory surgery centers and hospital outpatient surgery departments starting next year.

By Meg Bryant • Oct. 17, 2018

#AHIPMMD: Verma touts MA growth, blasts Medicare for all

So far, 270 Medicare Advantage plans will offer new benefits allowed for 2019 that include adult day care and meals, the CMS administrator said at the annual payer conference.

By Samantha Liss • Oct. 17, 2018

GAO study underscores health benefits of Medicaid expansion

Voters in four states will decide on expansion initiatives in the midterm elections next month.

By Meg Bryant • Oct. 16, 2018

CVS CEO unfazed by Amazon, focused on closing merger, growth

In a speech to the Economic Club of Washington, Larry Merlo said his goal is to not "leave any white space for Amazon to disrupt."

By Rebecca Pifer Parduhn • Oct. 16, 2018

UnitedHealth grows Q3 revenue, eyes 2019 expansion

The country's largest commercial payer picked up 2.8 million members, including more than 500,000 in Medicare Advantage, over the past year.

By Les Masterson • Oct. 16, 2018

Aetna settles HIV disclosure investigation for close to $650K

The multistate settlement stems from 2017 mailings that revealed some policyholders' HIV/AIDS or A-fib status.

By Meg Bryant • Oct. 15, 2018

Immigration rule change could force millions off Medicaid, report warns

The Trump administration is proposing a change to "public charge" policies that could also lead to higher costs for providers via uncompensated care and more ER visits, according to the Kaiser Family Foundation.

By Les Masterson • Oct. 15, 2018

States requiring hospitals provide more info on 340B drugs

Most states don't track 340B drug payments after rebates, but gaining that information could ultimately result in a change to reimbursement amounts.

By Les Masterson • Oct. 15, 2018

Grassley urges FTC to investigate hospital-payer contracts

The Senate Judiciary chairman is concerned that anticompetitive contracts could limit access to affordable care.

By Meg Bryant • Oct. 12, 2018