Medicare ACOs save more money with more time, Avalere says

The Medicare Shared Savings Program has been scrutinized recently as more performance data surface. After the initiative missed federal cost savings projections from 2013 to 2016, recent results have been more promising.

By Les Masterson • Sept. 19, 2018

Why payers are gobbling up PBMs

On Monday the Justice Department gave its blessing to a $67 billion acquisition of Express Scripts by Cigna.

By Samantha Liss • Sept. 18, 2018

CMS proposes streamlining some Medicare compliance rules

If finalized, the rule would remove the requirement that ambulatory surgical centers have a written transfer agreement with a hospital or that the center's physicians have admitting privileges at a nearby hospital.

By Tony Abraham • Sept. 18, 2018

NQF report focuses on rural-relevant quality measures

The National Quality Forum's Measure Applications Partnership workgroup looked for measures that are cross-cutting, resistant to low case volume and drive access to care.

By Meg Bryant • Sept. 18, 2018

Challenge to short-term plans joins chorus of ACA lawsuits

While the outcome of a lawsuit threatening the landmark law is pending in Texas, patient advocates in Washington, D.C., and the Maryland attorney general are suing to protect the act.

By Les Masterson • Sept. 17, 2018

Cigna-Express Scripts merger cleared by DOJ

Federal regulators said the deal "is unlikely to result in harm to competition or consumers." Eyes now turn to the proposed Aetna-CVS union.

By Samantha Liss • Sept. 17, 2018

Patient attribution crucial part of value-based contracting, actuaries say

There are trade-offs between attribution methods that rely on retrospective reviews of fee-for-service claims and those that attribute patients in advance of performance periods, according to a Society of Actuaries report.

By Les Masterson • Sept. 17, 2018

Hospitals, telehealth providers prepare for Hurricane Florence

As with last year's Hurricanes Harvey and Irma, hospital operators in Florence's path could take a financial hit. HCA, Tenet, Community Health Systems and LifePoint Health could all see volumes dip.

By Meg Bryant • Sept. 14, 2018

Payer trade group highlights need for housing programs

Housing is one of the most complex social determinants of health, and insurers have partnered with other health organizations to invest in affordable real estate and expand case management services, according to AHIP.

By Les Masterson • Sept. 14, 2018

Evolent buys New Century Health to beef up specialty care

The value-based care services company is looking to expand its influence over costs and move into Medicare Advantage, a high-growth area.

By Les Masterson • Sept. 13, 2018

Managed care companies, providers would benefit from Medicaid expansion

Four states with ballot initiatives this fall to expand Medicaid could boost bottom lines of big-name payers and health systems, according to a new report.

By Les Masterson • Sept. 12, 2018

California law brings more scrutiny of payer mergers

Payers must get approval from the state for any transaction that affects a "significant number of enrollees," "involves a material amount of assets" or adversely affects "the stability of the health care delivery system."

By Les Masterson • Sept. 12, 2018

Michigan threatens to repeal Medicaid expansion if work requirements not approved

Two JAMA studies bolster critics of work requirements who say most Medicaid recipients who are able to work are already doing so, and tracking compliance will heap more administrative burden onto an already-taxed system.

By Rebecca Pifer Parduhn • Sept. 12, 2018

In big payer win, court sides with UnitedHealth on MA overpayment rule

A federal judge vacated the rule, which the insurers said created additional burdens for Medicare Advantage plans not consistent with traditional Medicare regulations.

By Les Masterson • Sept. 10, 2018

Modest ACA plan premium changes expected for 2019

Following a year of concern about hefty rate increases and the possibility of some counties not having any ACA plan options, 2019 is shaping up to be a stable year for the exchanges.

By Les Masterson • Sept. 10, 2018

Montana co-op wins $5.3M CSR lawsuit

The judge ruled that the federal government didn't fulfill its obligation under the ACA when it stopped the cost-sharing reduction payments last year.

By Les Masterson • Sept. 7, 2018

Physician-led ACOs saw savings in Medicare program

Hospital-integrated ACOs, however, didn't have the same success, according to a study published in the New England Journal of Medicine.

By Les Masterson • Sept. 6, 2018

Premiums rise when hospitals buy doctor practices, study finds

The study in Health Affairs also found prices were likely to rise for outpatient visits as private practices were acquired or vertically integrated with hospital systems.

By Samantha Liss • Sept. 6, 2018

More patients sidestepping ED for low-acuity problems

Despite growing use of lower-cost care options, spending for low-acuity conditions rose 14% between 2008 and 2015, according to a report published in JAMA Internal Medicine.

By Meg Bryant • Sept. 6, 2018

JAMA studies show upsides of CMS bundled payment models

The reports found reduced institutional post-acute discharges with the CJR program and no increase in patient volume for the BPCI model.

By Les Masterson • Sept. 6, 2018

PhRMA, hospital war over drug prices heats up

The drugmaker lobby issued a report contending hospitals upcharge meds by 500% as a hospital-led effort to develop cheaper generics took a step forward.

By Rebecca Pifer Parduhn • Sept. 6, 2018

WellCare's Meridian purchase boosts Medicaid market share

When Tampa, Florida-based WellCare announced the deal in May, it said the transaction would put it in the leading Medicaid market position for six states.

By Les Masterson • Sept. 5, 2018

Gottlieb: UnitedHealth, CareFirst sign onto FDA pilot aiming to speed device coverage

The FDA chief also outlined new programs including "QUiK Review" aimed at cutting review times for well-understood, low-risk 510(k) submissions "by as much as 30%."

By David Lim • Sept. 5, 2018

Amazon's stock valuation hits $1T

Outside of the strictly retail space, Amazon is rushing into healthcare headfirst with new hires and acquisitions as well as its joint venture with Berskhire Hathaway and J.P. Morgan.

By Ben Unglesbee • Sept. 5, 2018

Cigna names chief data and analytics officer

The appointment comes as the insurer attempts to swallow pharmacy benefits manager Express Scripts.

By Susan Kelly • Sept. 5, 2018