Clover Health expanding MA offerings to 6 more markets

The San Francisco-based payer also announced it is working with Taiwan-based Cathay Life Insurance to use artificial intelligence products that can predict elements like what patients will need hospitalization and when.

By Les Masterson • Aug. 27, 2018

Medicaid expansion decreased uninsured hospitalizations for major cardiovascular events

A study of more than 3 million non-Medicare hospitalizations from databases across 30 states didn't, however, find any changes for in-hospital mortality rates in expansion or non-expansion states.

By Les Masterson • Aug. 27, 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

New CMS model aims to improve child behavioral health services, tackle opioid abuse

The program requires states to integrate behavioral health with primary care and preventive medicine and to use the help of community groups.

By Les Masterson • Aug. 27, 2018

GAO highlights 3 ways HHS can improve ACA exchange membership

The new report reviewed Trump administration efforts that likely led to fewer signups during open enrollment.

By Les Masterson • Aug. 24, 2018

Kaiser posts nearly $40B in revenue for H1, but net income drops 21%

Kaiser invested $26 million on capital projects, including opening new facilities and upgrading existing ones, and launched a $200 million project aimed at reducing homelessness.

By Meg Bryant • Aug. 24, 2018

Cigna, Express Scripts shareholders greenlight deal

About 90% of Cigna votes were cast in favor of the acquisition, according to preliminary results. The $67 billion deal is still subject to a number of regulatory approvals. 

By Tony Abraham • Updated Aug. 27, 2018

Slavitt group, 17 health systems come together in effort to improve Medicaid

About 5% of the nation's hospitals are participating in the new project, which includes big names like Advocate Aurora, Dignity Health and Geisinger.

By Les Masterson • Aug. 23, 2018

Mobile phones, smartphone apps could help boost patient matching, RAND report finds

There's "no magic bullet" for incentivizing patients to improve record matching, according to lead author Robert Rudin.

By Meg Bryant • Aug. 22, 2018

Questions remain about MA supplemental benefits for chronically-ill members

In a new report, the Bipartisan Policy Center said HHS and CMS will need to figure out a balance between loosening restrictions for population health programs and opening up vulnerabilities for fraud and abuse.

By Les Masterson • Aug. 22, 2018

Maryland reinsurance waiver secures federal approval

The state's reinsurance plan, which uses $800 million to keep ACA rates down, is being hailed as a bipartisan solution.

By Tony Abraham • Updated Aug. 22, 2018

Healthcare execs see Amazon as biggest disrupter

Apple and Google were among those also feared, though Amazon held a giant lead in the survey, according to a report from Reaction Data.

By Meg Bryant • Aug. 22, 2018

Verma talks Medicaid, preexisting conditions and fraud

Also at a congressional hearing Tuesday, GAO issued a report on CMS actions to combat Medicaid fraud.

By Les Masterson • Aug. 22, 2018

CMS gives $8.6M to states to help stabilize ACA exchanges

Thirty states and the District of Columbia will receive less than $300,000 each from rate review grants established by the Affordable Care Act.

By Les Masterson • Aug. 21, 2018

Medicare overpaid millions for outpatient planning services

A report from the HHS Office of Inspector General blamed the excessive payments for intensity-modulated radiation therapy planning services mostly on hospitals not knowing or misinterpreting CMS guidance.

By Les Masterson • Aug. 21, 2018

Anthem, Walmart partner on MA program aimed at improving OTC access

The retail giant's focus on value-based care and bid to innovate may be a lesson learned from earlier this year when a deal to acquire Pill Pack fell though and e-commerce competitor Amazon grabbed the startup for itself.

By Rebecca Pifer Parduhn • Aug. 20, 2018

CMS touts quicker Medicaid waiver process

The agency said its efforts reduced administrative burdens for states and the government.

By Les Masterson • Aug. 20, 2018

Rural hospitals in dire need of regulatory relief

"Reducing some of the costly regulatory challenges we face would help staunch the bloodletting," said Leslie Marsh, CEO of Lexington Regional Health Center.

By Meg Bryant • Aug. 17, 2018

Providence Health slapped with $188M False Claims Act lawsuit

The Renton, Washington-based health system is accused of adding spurious secondary diagnoses to Medicare claims to increase reimbursements.

By Meg Bryant • Aug. 17, 2018

Moving to electronic transactions could save Medicaid plans over $4.8B annually

A new report finds only 44% of Medicaid recipients are currently in plans with electronic claims processes.

By Les Masterson • Aug. 17, 2018

Payers transition to government health plans despite risks

Commercial health plans have dropped over the past 10 years as payers move to managed Medicaid and Medicare Advantage.

By Les Masterson • Aug. 16, 2018

Insurance brokers expect higher ACA plan premiums, market instability

Brokers predict more people will leave individual insurance for lower-cost options like short-term health plans and association health plans.

By Les Masterson • Aug. 16, 2018

Oscar gets $375M investment from Alphabet, eyes MA market in 2020

The payer startup has already expanded beyond its initial offerings in the ACA exchanges and individual market.

By Les Masterson • Aug. 15, 2018

Partial Medicaid expansion would restrict access for near-poor adults, study finds

Wisconsin is the only state so far to partially expand the program, but at least three other states are considering such a proposal, according to a Center on Budget and Policy Priorities report.

By Les Masterson • Aug. 15, 2018

Prior authorization moves to EHRs

Manual prior authorization can create administrative burdens for practices and hospitals, but case studies show some success in making the process electronic.

By Les Masterson • Aug. 15, 2018

Nearly 20% of inpatient admissions include out-of-network charge

A Kaiser Family Foundation report found the issue of surprise billing is especially problematic for care in ERs and for psychological or substance abuse treatment.

By Les Masterson • Aug. 14, 2018