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

Explore the Trendline➔

Payer/provider relationships

As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

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The proposed rule from CMS aims to create flexibility by removing "outdated" requirements that govern how plans communicate with beneficiaries and barriers to transitioning new services and populations into managed care.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

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