Payer: Page 114
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Medigap plans rise in popularity but coverage geographically sparse, AHIP says
A new report from the insurance lobby found more than 13 million beneficiaries have a Medigap plan.
By Les Masterson • June 13, 2018 -
Deep Dive
New Medicare Advantage rules hold big potential for pop health
A CMS rule taking effect this week lets payers offer benefits like ride-hailing and nutrition support to boost health.
By Meg Bryant • June 13, 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 -
FDA permits more expansive communication between drugmakers, payers
The move seeks to smooth adoption of value-based contracts, including clarity on what economic information or analyses drugmakers can share with payers about their products.
By Ned Pagliarulo • June 13, 2018 -
AMA, industry leaders call on CMS to expand remote patient monitoring reimbursement
The agency took a step toward broader remote monitoring reimbursement with the unbundling of CPT 99091 in the 2018 Physician Fee Schedule final rule.
By Meg Bryant • June 12, 2018 -
CMS sets goals to tackle opioid crisis
The plan calls for greater data transparency and interoperability and use of the Medicare heat map to pinpoint areas that can benefit from targeted safe prescribing efforts.
By Meg Bryant • June 12, 2018 -
CMS expands Maryland's all-payer program to outpatient services
The agency said the new model will save Medicare more than $1 billion by the end of 2023 and "creates new opportunities for a range of non-hospital healthcare providers to participate in this test to limit Medicare spending."
By Les Masterson • June 12, 2018 -
Anthem ED policy a sticking point in Indiana contract dispute
Saint Joseph Health System mailed a letter to patients warning they could soon face out-of-network costs if it does not agree to new terms with the payer by the end of the month.
By Les Masterson • June 12, 2018 -
Fixing provider directories a low-risk way to test blockchain, report suggests
UnitedHealth, Humana and Quest Diagnostics are among those working on a pilot blockchain project to update provider directories.
By Les Masterson • June 11, 2018 -
Geisinger's revenue, operating income up in first 9 months of FY 18
The health system attributed the growth to higher patient service and premium revenues.
By Meg Bryant • June 8, 2018 -
ED visits increased nearly 10% in California after ACA
A Health Affairs study also found the chance of a Medicaid enrollee being a frequent ED user was "significantly lower" after the Affordable Care Act was signed into law.
By Les Masterson • June 8, 2018 -
DOJ argues ACA pre-existing condition, individual mandates unconstitutional
The Trump administration said that with Congress zeroing out the penalty starting in 2019, the health law's individual mandate, community rating and guaranteed issue provisions cannot stand.
By David Lim • Updated June 8, 2018 -
Study raises concerns about Medicaid managed care's narrow networks
A Health Affairs report said states need to make sure that physician turnover in narrow network plans doesn't create issues with doctor continuity for vulnerable populations.
By Les Masterson • June 7, 2018 -
Bucking national trend, Pennsylvania payers seek modest exchange premium hikes
While many states worry there will be less competition in the individual market next year, Pennsylvania is seeing an uptick of participation in the exchange.
By Les Masterson • June 6, 2018 -
Medicaid expansion improved care access and coverage, analysis finds
More than 30 states have expanded Medicaid under the ACA, and a few more will have the issue up for a vote this fall.
By Les Masterson • June 6, 2018 -
Mandatory CMS bundles showed advantages over voluntary initiatives, report finds
A Health Affairs report found mandatory and voluntary bundled payment models "engaged different types of hospitals."
By Les Masterson • June 6, 2018 -
BCBS of Texas delays unnecessary ED visit policy
The Texas Department of Insurance requested the delay and questioned the payer on the new policy.
By Les Masterson • June 5, 2018 -
Payer-provider partnerships on record pace
So far this year, 22 alliances have been formed, with more than 90% using value-based reimbursement as a component.
By Les Masterson • June 4, 2018 -
Losing ACA mandate penalty will reverse coverage gains, report finds
A Brookings analysis that focused on those not eligible for ACA subsidies found the individual mandate was the major reason the group got insured.
By Les Masterson • June 4, 2018 -
Omission of observation stays in readmission measures misses key patient cohort, analysis suggests
The rate of 30-day readmissions for observation stays between 2007 and 2015 increased while inpatient readmissions declined, according to a New England Journal of Medicine paper.
By Meg Bryant • June 1, 2018 -
AMA trumpets physician efforts in opioid epidemic fight
The doctors' group said opioid prescriptions are down while prescription drug monitoring program queries are up.
By Les Masterson • June 1, 2018 -
Trump administration pushes 340B ceiling price rule to 2019
It is the fifth delay for the rule, which would also set a penalty for drugmakers that overcharge participating hospitals.
By Tony Abraham • June 1, 2018 -
Getty / Edited by Healthcare Dive
UnitedHealth CEO predicts dramatic hike in value-based program participation
David Wichmann told investors that the payer is focused on using its care delivery arm to push patients who don’t need emergency care toward a more appropriate setting.
By Shannon Muchmore , Tony Abraham • June 1, 2018 -
Technology, value-based care driving M&A, report says
Buyers are looking for targets that can respond quickly to regulatory and market changes.
By Meg Bryant • May 31, 2018 -
Industry group offers roadmap to greater provider directory accuracy
One of the first challenges is defining who is and is not a provider, according to a CAQH white paper.
By Meg Bryant • May 31, 2018 -
Deep Dive
Days of information blocking look numbered
Government pressure and emerging business incentives are encouraging companies to share data.
By Meg Bryant • May 31, 2018
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