Payer: Page 111
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ACA risk adjustment fix reportedly in the works
An interim final rule that could reinstate the $10.4 billion in risk adjustment payments to insurers CMS suspended earlier this month is being considered by the Office of Management and Budget.
By Tony Abraham • July 20, 2018 -
Drug lobby ramps up jabs at PBMs with pitch to curb rebates
PhRMA wants PBMs to be compensated on a fee-for-service basis, rather than from a percentage cut of a drug's list price.
By Ned Pagliarulo • July 19, 2018 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
Healthcare consumerism efforts lacking, report finds
Payers are outperforming providers and pharma companies in data use, implementing information from wearable tech, claims and clinical forms, according to the Prophet study.
By Les Masterson • July 19, 2018 -
ACA Medicaid pay boost didn't lure docs, JAMA study says
Possible reasons for this lack of interest were delayed payments, a finite timeframe and documentation requirements to qualify.
By Les Masterson • July 18, 2018 -
Humana study touts telehealth cost cuts, with comparable follow-ups
The payer's study, which used data from Doctor on Demand, found that virtual care consultations cost one-third less than in-office visits.
By Rebecca Pifer • July 18, 2018 -
Anthem sued by doc groups over ED policy
American College of Emergency Physicians President Paul Kivela called the policy dangerous in expecting patients to know the difference between minor or potentially life-threatening conditions.
By Les Masterson • July 17, 2018 -
Getty / Edited by Healthcare Dive
UnitedHealth sees 12% revenue hike boosted by new members, Optum results
Membership increased by 2.2 million for the second quarter, driven largely by Medicare and Medicaid growth.
By Les Masterson • July 17, 2018 -
Walmart taps former Humana exec to lead health unit
Reports that the retailer is in early talks to acquire Humana surfaced in late March but have been tamped down to a conversation about strengthening the companies' partnership.
By Tony Abraham • July 17, 2018 -
Industry groups launch guide for managing high-need, high-cost patients
Patients with complex medical, social and behavioral needs make up 5% of the U.S. population but account for roughly 50% of annual healthcare spending.
By Rebecca Pifer • July 16, 2018 -
Major payers unlikely to see financial hit from risk-adjustment halt, Fitch says
But the decision to halt the payments is likely to destabilize the individual market, according to the ratings agency.
By Les Masterson • July 16, 2018 -
Docs shouldn't be held accountable for healthcare costs, NEJM survey finds
Industry experts say out-of-pocket costs are important to patients but there are multiple barriers to properly educating them about healthcare pricing.
By Les Masterson • July 16, 2018 -
Healthcare sector leads in costs for data breaches, study finds
For mega breaches, the cost to an organization can run from $40 million to $350 million in lost business, recovery efforts and tarnished reputation.
By Meg Bryant • July 13, 2018 -
More insurers using outcomes-based deals with drug, device companies
Heart, infectious diseases and oncology are the top three therapeutic areas where the contracts are used, according to an Avalere survey.
By Meg Bryant • July 13, 2018 -
HHS OIG cites flawed efforts to prevent fraud in Medicaid managed care
A new report found that not all managed care organizations use proactive data analysis or inform states when providers are suspected of abuse.
By Les Masterson • July 13, 2018 -
Many docs support MIPS concepts, but a big chunk unaware
Nearly two-thirds of physicians surveyed reported little or no knowledge of the CMS Merit-based Incentive Payment System.
By Meg Bryant • July 12, 2018 -
Employer health insurance cost growth cut in half
Potential factors behind the trend include preemptive moves by employers to avoid the Affordable Care Act's excise tax on high-cost plans, cost-shifting and the rise of high-deductible plans, according to a new Mercer report.
By Les Masterson • July 12, 2018 -
ACA plan member costs increasing, networks narrowing, study says
Avalere, which conducted the report for the Physicians for Fair Coverage, said restricted networks are resulting in more out-of-network care and surprise billing.
By Les Masterson • July 12, 2018 -
Medtronic, UnitedHealthcare say value-based pact cut diabetes costs
The biggest U.S. payer and largest medical device company saw encouraging results in the program's first year.
By Susan Kelly • July 11, 2018 -
MA outperforms traditional Medicare for people with chronic conditions, study finds
The Avalere report showed better quality metrics for inpatient stays, ER visits, preventive screenings and costs.
By Rebecca Pifer • July 11, 2018 -
CMS will let providers withdraw retroactively from BPCI-A
The agency is not, however, delaying the program's Oct. 1 start date.
By Les Masterson • July 11, 2018 -
MA star ratings would change if socioeconomic status taken into account, study finds
The report in Health Affairs evaluated how scoring changes connected to blood pressure, diabetes and cholesterol control could improve plan ratings.
By Les Masterson • July 11, 2018 -
Cerner, Lumeris team up on population health
As part of the 10-year deal, Cerner will acquire a minority stake in the population health management firm.
By Meg Bryant • July 10, 2018 -
Trump administration suspends ACA risk-adjusted payments
The freeze impacts $10.4 billion for 2017. Without the program to stabilize the marketplace, premiums are expected to rise.
By Tony Abraham • July 9, 2018 -
Centene completes Fidelis Care buy
The $3.75 billion deal gives Centene a big presence in New York State.
By Meg Bryant • July 6, 2018 -
Healthcare M&A doubles in first half of 2018
Total sector deals totaled $315.74 billion this year, up from $154.87 billion in the first half of 2017.
By Meg Bryant • July 6, 2018
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