Payer: Page 111
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Medicare Advantage premiums expected to drop again
CMS predicted 36% of Medicare beneficiaries will have an MA plan in 2019, and more than 90% of them will have 10 or more plans to choose from.
By Les Masterson • Oct. 1, 2018 -
Three-fourths of Medicare Advantage denials overturned on appeal, OIG finds
The investigation revealed "widespread and persistent" problems with Medicare Advantage organization denial decisions and letters.
By Meg Bryant • Sept. 28, 2018 -
Supreme Court to hear DSH payments case
An appellate court found HHS violated the Medicare Act by altering the formula for disproportionate share hospital payments without public notice and comment.
By Meg Bryant • Sept. 28, 2018 -
Deep Dive
Hospitals prepare for uncompensated care payment change
The move is meant to even the playing field for hospitals and create more transparency.
By Les Masterson • Sept. 28, 2018 -
Employer-based health insurance offerings increase for first time in decade
Healthcare costs, however, remain a major concern for small businesses, according to the Employee Benefit Research Institute.
By Les Masterson • Sept. 28, 2018 -
Bipartisan opioid bill has IMD exclusion, expands MAT
The legislation, which also opens up non-addictive pain management alternatives and increases enforcement of illegal fentanyl, is expected to pass both houses as early as next month.
By Les Masterson • Sept. 27, 2018 -
Montgomery County Planning Commission
Aetna sells Medicare Part D business to WellCare subsidiary
The deal is meant to grease the wheels for approval of the payer's pending $69 billion acquisition by CVS.
By Samantha Liss • Sept. 27, 2018 -
Safety-net hospitals get break on FY19 readmission penalties, analysis finds
Some penalties are being cut by half or more, and 65 safety-net facilities that were penalized last year will see no dock at all this year, according to a data review by Kaiser Health News.
By Les Masterson • Sept. 27, 2018 -
AHA study finds hospital outpatient departments see sicker, poorer Medicare patients than independent docs
The research comes as CMS is proposing site neutral payment for hospital and nonhospital outpatient clinics.
By Meg Bryant • Sept. 26, 2018 -
UnitedHealthcare threatens to drop Envision providers
Envision, which employs more than 23,000 clinicians, said it is preparing to continue to serve patients and hospitals "without disruption regardless of the contract status with any payer."
By Les Masterson • Sept. 26, 2018 -
Maryland reinsurance program credited for premium decreases
Before CMS approved the program, the state's four individual health plans requested an average increase of 30.2%, but they have now put forward rates with an average decrease of 13.2%.
By Les Masterson • Sept. 26, 2018 -
Medicaid expansion particularly helped rural areas, small towns, report finds
"Overall, the experience of Medicaid expansion states demonstrates the great opportunity for states that have not yet expanded Medicaid," Jack Hoadley, lead author of the report, said in a statement.
By Les Masterson • Sept. 26, 2018 -
Montgomery County Planning Commission
New York regulator warns CVS-Aetna merger could raise prices, reduce consumer choice
The state's top financial watchdog said the pharmacy chain's PBM would have an incentive to give the largest drug discounts to Aetna members, causing "anti-competitive effects" in the rest of the market.
By Samantha Liss • Sept. 26, 2018 -
CVS execs promote proposed Aetna merger as cost saver
The deal would allow the pharmacy chain to have more touch points with the payer's members, particularly those with chronic diseases, company leaders said.
By Samantha Liss • Sept. 25, 2018 -
Reports explore connection between race, ethnicity, socioeconomics, health
The study by U.S. News and the Aetna Foundation found that the strongest predictors of community health performance were factors like high homicide rates, low birth weight and access to healthy, affordable food.
By Les Masterson • Sept. 25, 2018 -
Major healthcare groups question Medicare ACO proposal
CMS would like more providers to take on risk, but practices have been slow to transition.
By Les Masterson • Sept. 24, 2018 -
Medicaid spending increase expected to exceed GDP growth over next decade
A new HHS Office of the Actuary report projected an average annual rate increase of 5.7% until 2026.
By Les Masterson • Sept. 24, 2018 -
CMS chooses organizations to help develop QPP quality measures
The seven participants include a hospital, specialty groups, colleges and an employer coalition. Their focus areas will include mental health, orthopedic surgery, pathology, radiology and palliative care.
By Les Masterson • Sept. 24, 2018 -
Amazon-JPM-Berkshire venture reportedly hires consulting powerhouse
Chronic conditions make up 86% of the nation's $2.7 trillion annual healthcare bill, according to the CDC.
By Meg Bryant • Sept. 21, 2018 -
Iowa's Medicaid managed care costs rise faster than before
Medicaid per-member costs increased an average of 4.4% in the first full year of privatization. That's nearly triple the 1.5% average the previous six years.
By Les Masterson • Sept. 21, 2018 -
Fitbit rolls out connected health platform for health plans, employers
The tool leverages the company's wearables technology with Twine Health's disease management know-how.
By Meg Bryant • Sept. 20, 2018 -
Lack of consistent process hinders data sharing among HHS agencies, report finds
Issues include lack of processes and accountability for data sharing, as well as resource constraints.
By Meg Bryant • Sept. 20, 2018 -
Change Healthcare deploys blockchain network on Amazon Web Services
The cloud-based network will let providers and payers track claims submissions and payments in real time.
By Meg Bryant • Sept. 20, 2018 -
Prescriptions, ED visits, outpatient services drive healthcare spending growth
The Health Care Cost Institute found that employer-sponsored insurance spending increased by 44% between 2007 and 2016.
By Les Masterson • Sept. 20, 2018 -
Senators take aim at surprise billing
A draft bill from a bipartisan group would ban balance billing and require that insurers, rather than patients, pay out-of-network providers at 125% of the average in-network rate.
By Tony Abraham • Sept. 19, 2018
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