AHA continues to push HHS on Medicare billing backlog

AHA and three member hospitals are suing the agency and in the latest court filing suggested methods for reaching a court-ordered 2020 deadline for getting through the claims.

By Les Masterson • Aug. 14, 2018

Primary care docs easier to find in ACA plans than Medicaid, study finds

Physicians are even more likely to participate in employer-sponsored health plans, according to the Health Affairs report.

By Les Masterson • Aug. 13, 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

More than 20% of Americans skip medical care due to cost, survey finds

More than half of respondents said they are very or somewhat concerned that they may not have affordable health insurance in the future.

By Meg Bryant • Aug. 10, 2018

Cigna wins Texas underpaid claims lawsuit

North Cypress Medical Center charged that the payer owed $50 million in unpaid claims, but Cigna said the hospitals's fee-forgiving policy for out-of-network care is illegal.

By Les Masterson • Aug. 10, 2018

Massachusetts fumbles on telehealth parity bill

Last year, the American Telemedicine Association gave the state an F on telehealth parity.

By Meg Bryant • Aug. 9, 2018

AI can save US insurers $7B in admin costs, Accenture says

The savings could stem from streamlining core functions for payers across the board, including customer service, billing, enrollment, claims and quality and compliance.

By Rebecca Pifer Parduhn • Aug. 9, 2018

AMA charges CVS-Aetna deal would reduce competition

The analysis came as Bloomberg reported that the Justice Department won't oppose the merger based on vertical competition issues, although it may still be looking at how it will affect the pharmacy market.

By Les Masterson • Aug. 9, 2018

Academic medical centers lag behind other facilities for cost, quality

Despite improvements on some metrics, AMCs still face more Medicare value-based program penalties, according to a Navigant report.

By Les Masterson • Aug. 9, 2018

CVS rejects pharma claim that rebates push up drug prices

Responding to charges that PBMs pocket much of drug rebates, the pharmacy giant said it retains only 2% of the price concessions from drugmakers. 

By Ned Pagliarulo • Aug. 9, 2018

CVS rolls out virtual care offering in 9 states

The program leverages Teladoc's technology platform and is available through the CVS app.

By Meg Bryant • Aug. 9, 2018

ACOs using medical home physicians save money, yield higher quality, report finds

"ACOs and patient-centered medical homes are cut out of the same cloth," Robert Mechanic, executive director of the Institute for Accountable Care, said about the research.

By Rebecca Pifer Parduhn • Aug. 8, 2018

Small, medium payers show growing interest in provider-sponsored plans

A new white paper looked at that payer marketplace niche, which has seen significant turnover in the past five years.

By Les Masterson • Aug. 8, 2018

Small company employees with high-deductible plans get less help with out-of-pocket costs

More than three-fourths of HDHP members in small companies don't have an employer-funded account, according to a study from researchers at the Agency for Healthcare Research and Quality.

By Les Masterson • Aug. 8, 2018

Humana sues drugmakers alleging generic price-fixing scheme

The insurance giant's civil suit, which lists 16 drugs and nearly 30 drugmakers, closely tracks ongoing federal and state criminal investigations.

By Andrew Dunn • Aug. 8, 2018

5 takeaways from payer Q2 earnings reports

Health insurers found success in Medicare, Medicaid and even the ACA exchanges.

By Les Masterson • Aug. 8, 2018

Cigna claps back at Icahn in defense of Express Scripts acquisition

In a lengthy letter to shareholders, Cigna claims activist investor Carl Icahn's disapproval of its pending deal with Express Scripts is "misguided and short-sighted." Shareholders will vote on the deal Aug. 24.

By Tony Abraham • Aug. 8, 2018

CMS to allow step therapy in MA plans in bid to boost price competition

Dan Best, CMS senior advisor for drug pricing reform, told reporters the policy could save 15-20% of the $12 billion annual spend by MA plans on oft-pricey Part B drugs. Not all analysts buy that estimate.

By David Lim • Aug. 8, 2018

Market concentration tied to higher premiums in ACA markets, study finds

Premiums in marketplaces with monopolist insurers were 50% higher than in markets with more than two insurers, according to a Health Affairs report.

By Meg Bryant • Aug. 7, 2018

GM contracting directly with Henry Ford Health System

The companies say the new plan is forecasted to save employees between $300 and $900 per year in healthcare costs without raising deductibles.

By Rebecca Pifer Parduhn • Aug. 7, 2018

Icahn blasts Cigna-Express Scripts deal as among 'worst acquisitions in corporate history'

The activist investor warned that PBMs are under a political microscope too risky for Cigna investors, also citing risks from Amazon. Shareholders vote on the deal Aug. 24.

By David Lim • Aug. 7, 2018

CMS' Verma stands firm on 2015 EHR deadline, move to open APIs

Meanwhile, the coalition Health IT Now sent a letter to ONC chiding the government for failing to implement information blocking provisions of the 21st Century Cures Act.

By Meg Bryant • Aug. 7, 2018

Kaiser Permanente's Q2 revenue growth driven by higher premiums, new members

The Oakland-based health system also saw a 47% decrease in operating revenue that it blamed on a new accounting standard.

By Les Masterson • Aug. 7, 2018

More employers look toward value-based insurance plans

After years of implementing cost-sharing policies like the use of high-deductible plans, businesses are looking for new avenues to reduce costs and improve health.

By Les Masterson • Aug. 6, 2018

Healthcare M&A remains hot, but value fell in Q2

Despite the activity, there was only one industry megadeal in the quarter — KKR's $10 billion buy of Envision.

By Les Masterson • Aug. 3, 2018

Opioid prescriptions aren't decreasing, study finds

The results come despite myriad attempts from lawmakers, providers and payers to curb opioid use, including prescribing and dosage restrictions.

By Les Masterson • Aug. 2, 2018