Liability immunity reduces defensive medicine without hurting outcomes, paper says

When doctors are immune from liability they order fewer tests and procedures, reducing inpatient spending by 5%, according to the study from the National Bureau of Economic Research.

By Meg Bryant • July 24, 2018

UnitedHealth sees growing interest in ACOs

The nation's largest private payer expects ACOs will continue to grow over the next year as employers look for ways to cut costs and improve quality.

By Les Masterson • July 23, 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

State individual mandates would boost coverage, curb premiums

The Commonwealth Fund reported there would be more than 7 million fewer uninsured people in 2022 if all states implemented individual mandates.

By Les Masterson • July 23, 2018

UnitedHealth eyes Tenet's healthcare management business, WSJ reports

Tenet is still weighing whether to sell Conifer, which accounted for 8% of the company's revenue in 2017.

By Meg Bryant • July 20, 2018

Controversial Anthem ER policy under fire in lawmaker's report

Under its policy of denying payment for ER visits later determined not to be emergencies, the insurer denied 5.8% of claims in three states across a six-month stretch in 2017. On appeal, a majority of those were later overturned.

By Rebecca Pifer Parduhn • July 20, 2018

ACA risk adjustment fix reportedly in the works

An interim final rule that could reinstate the $10.4 billion in risk adjustment payments to insurers CMS suspended earlier this month is being considered by the Office of Management and Budget. 

By Tony Abraham • July 20, 2018

Drug lobby ramps up jabs at PBMs with pitch to curb rebates

PhRMA wants PBMs to be compensated on a fee-for-service basis, rather than from a percentage cut of a drug's list price.

By Ned Pagliarulo • July 19, 2018

Healthcare consumerism efforts lacking, report finds

Payers are outperforming providers and pharma companies in data use, implementing information from wearable tech, claims and clinical forms, according to the Prophet study.

By Les Masterson • July 19, 2018

ACA Medicaid pay boost didn't lure docs, JAMA study says

Possible reasons for this lack of interest were delayed payments, a finite timeframe and documentation requirements to qualify.

By Les Masterson • July 18, 2018

Humana study touts telehealth cost cuts, with comparable follow-ups

The payer's study, which used data from Doctor on Demand, found that virtual care consultations cost one-third less than in-office visits.

By Rebecca Pifer Parduhn • July 18, 2018

Anthem sued by doc groups over ED policy

American College of Emergency Physicians President Paul Kivela called the policy dangerous in expecting patients to know the difference between minor or potentially life-threatening conditions.

By Les Masterson • July 17, 2018

UnitedHealth sees 12% revenue hike boosted by new members, Optum results

Membership increased by 2.2 million for the second quarter, driven largely by Medicare and Medicaid growth.

By Les Masterson • July 17, 2018

Walmart taps former Humana exec to lead health unit

Reports that the retailer is in early talks to acquire Humana surfaced in late March but have been tamped down to a conversation about strengthening the companies' partnership.

By Tony Abraham • July 17, 2018

Industry groups launch guide for managing high-need, high-cost patients

Patients with complex medical, social and behavioral needs make up 5% of the U.S. population but account for roughly 50% of annual healthcare spending.

By Rebecca Pifer Parduhn • July 16, 2018

Major payers unlikely to see financial hit from risk-adjustment halt, Fitch says

But the decision to halt the payments is likely to destabilize the individual market, according to the ratings agency.

By Les Masterson • July 16, 2018

Docs shouldn't be held accountable for healthcare costs, NEJM survey finds

Industry experts say out-of-pocket costs are important to patients but there are multiple barriers to properly educating them about healthcare pricing.

By Les Masterson • July 16, 2018

Healthcare sector leads in costs for data breaches, study finds

For mega breaches, the cost to an organization can run from $40 million to $350 million in lost business, recovery efforts and tarnished reputation.

By Meg Bryant • July 13, 2018

More insurers using outcomes-based deals with drug, device companies

Heart, infectious diseases and oncology are the top three therapeutic areas where the contracts are used, according to an Avalere survey.

By Meg Bryant • July 13, 2018

HHS OIG cites flawed efforts to prevent fraud in Medicaid managed care

A new report found that not all managed care organizations use proactive data analysis or inform states when providers are suspected of abuse.

By Les Masterson • July 13, 2018

Many docs support MIPS concepts, but a big chunk unaware

Nearly two-thirds of physicians surveyed reported little or no knowledge of the CMS Merit-based Incentive Payment System.

By Meg Bryant • July 12, 2018

Employer health insurance cost growth cut in half

Potential factors behind the trend include preemptive moves by employers to avoid the Affordable Care Act's excise tax on high-cost plans, cost-shifting and the rise of high-deductible plans, according to a new Mercer report.

By Les Masterson • July 12, 2018

ACA plan member costs increasing, networks narrowing, study says

Avalere, which conducted the report for the Physicians for Fair Coverage, said restricted networks are resulting in more out-of-network care and surprise billing.

By Les Masterson • July 12, 2018

Medtronic, UnitedHealthcare say value-based pact cut diabetes costs

The biggest U.S. payer and largest medical device company saw encouraging results in the program's first year.

By Susan Kelly • July 11, 2018

MA outperforms traditional Medicare for people with chronic conditions, study finds

The Avalere report showed better quality metrics for inpatient stays, ER visits, preventive screenings and costs.

By Rebecca Pifer Parduhn • July 11, 2018

CMS will let providers withdraw retroactively from BPCI-A

The agency is not, however, delaying the program's Oct. 1 start date.

By Les Masterson • July 11, 2018