ACA plans expanded coverage for chronic conditions

Repeal of the individual mandate penalty, which goes into effect next year, will likely put the burden on states to figure out how to stabilize the ACA exchanges.  

By Les Masterson • April 4, 2018

Medicaid FFS biggest factor in billing headaches, report finds

A Health Affairs study found that there are more challenged claims with traditional Medicaid than involving other payers. Also, Medicaid payments take longer to process than others, including Medicare.  

By Les Masterson • April 4, 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

Insurers bracing to hike premiums in 2019 and beyond

Despite worries about the individual market, consumers may not be running for the exits just yet.

By David Lim • April 4, 2018

Humana, Optum pilot blockchain to fix network lists

MultiPlan, UnitedHealthcare and Quest Diagnostics are also part of the initiative to use blockchain to ensure accuracy of network directories.

By Meg Bryant • April 3, 2018

Study finds 'pervasive' income disparities in pediatric hospitalizations

The report suggests that hospitals should spend more time on inpatient to outpatient transitions and on population health.

By Meg Bryant • April 3, 2018

Payers get better-than-expected Medicare Advantage rate increase

CMS also increased the role encounter data will play in determining risk scores and announced policies to target opioid abuse.  

By Les Masterson • April 3, 2018

Medicare ACOs missing federal cost-savings predictions, analysis finds

The finding raises questions about the long-term success of the Medicare Shared Savings Program, which has swelled to 561 ACOs from 27 six years ago.

By Meg Bryant • April 2, 2018

NQF report finds gaps in post-acute, long-term care measures

The report suggests a need for bidirectional measures that hold both referring providers and nursing homes accountable for care.

By Meg Bryant • April 2, 2018

States need more rules to protect individual insurance market

Changes made by the federal government may further destabilize the ACA exchanges, a new Commonwealth Fund report said.  

By Les Masterson • April 2, 2018

Walmart reportedly in early talks to acquire Humana

The companies already partner on Medicare Part D drug plans, but a deal, floated in the WSJ, could boost Humana's group market offerings to compete with other major insurers, a Mercer consultant suggests.

By David Lim • April 2, 2018

Oscar Health raises $165M from investors

The payer said profitability is "around the corner," but the ACA market it focuses on has not been lucrative for insurers and faces a potentially unstable future.  

By Les Masterson • March 29, 2018

GE, Medtronic among those linking with hospitals for value-based care

Manufacturers are putting their money where their mouth is — tying payment to real outcomes.  

By Meg Bryant • March 29, 2018

Healthcare M&A leading to higher prices in California

A University of California, Berkeley study said northern California pays much higher healthcare prices than the southern part of the state.  

By Les Masterson • March 28, 2018

Geisinger to build, co-own hospital with St. Luke's

The two systems work together frequently, including an insurance collaboration and an upcoming partnership that will see Geisinger providing St. Luke's with an emergency helicopter service.

By Tony Abraham • March 28, 2018

AHA argues HHS religious freedom rule unnecessary

The hospital group is also concerned that the proposed rule may endanger federal reimbursement if OCR takes action against a provider.

By David Lim • March 28, 2018

UnitedHealth countersues feds in $1B MA suit

UnitedHealth asks for the government's lawsuit be dismissed with prejudice and seeks relief "in an amount to be determined at trial."

By David Lim • March 28, 2018

HHS panel recommends testing 2 alternative palliative care payment models

Also, a new Health Affairs article explored the complexity of including hospice care in Medicare Advantage.  

By Les Masterson • March 28, 2018

Optum, HealthBI partner to improve MA plan performance

The software seeks to help providers quickly identify high-risk patients who can benefit most from coordinated care.

By Jeff Byers , Meg Bryant • March 27, 2018

BCBS Michigan pilots bundled model for hip, knee replacements

The program hopes to cut the cost of replacement surgeries by 10%. 

By Tony Abraham • March 27, 2018

Plans shirking ACA rules could spur more out-of-network care

Allowing health coverage to be sold across state lines could also limit oversight, a report by state regulators said.

By Les Masterson • March 27, 2018

Aetna to offer point of sale pharmacy rebates to 3M customers

The insurer has opposed the CMS idea to mandate that Part D sponsors pass on a percentage of rebates to customers at the point of sale.  

By David Lim • March 27, 2018

CMS mum on restricting how payers use subsidies

Insurers that offer ACA plans often use the practice of "silver loading," which involves putting all the losses associated with the end of CSR payments on only silver plans.

By Les Masterson • March 26, 2018

Payers use data to flag those at greatest risk of opioid abuse

The idea is to pinpoint patients most likely to become addicted and help prevent opioid abuse before it starts.

By Les Masterson • March 26, 2018

Most employers short of tipping point for health coverage

The American Health Policy Institute predicted employers won't be rushing to drop health insurance as a benefit, but some will go that route in the face of unmanageable healthcare costs.

By Les Masterson • March 26, 2018

CMS proposes to reduce state Medicaid requirements for monitoring access

The proposed rule is part of the Trump administration's drive to cut administrative red tape.

By Meg Bryant • March 23, 2018