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

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

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

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

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