Payer: Page 120
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MA star ratings would change if socioeconomic status taken into account, study finds
The report in Health Affairs evaluated how scoring changes connected to blood pressure, diabetes and cholesterol control could improve plan ratings.
By Les Masterson • July 11, 2018 -
Cerner, Lumeris team up on population health
As part of the 10-year deal, Cerner will acquire a minority stake in the population health management firm.
By Meg Bryant • July 10, 2018 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
Trump administration suspends ACA risk-adjusted payments
The freeze impacts $10.4 billion for 2017. Without the program to stabilize the marketplace, premiums are expected to rise.
By Tony Abraham • July 9, 2018 -
Centene completes Fidelis Care buy
The $3.75 billion deal gives Centene a big presence in New York State.
By Meg Bryant • July 6, 2018 -
Healthcare M&A doubles in first half of 2018
Total sector deals totaled $315.74 billion this year, up from $154.87 billion in the first half of 2017.
By Meg Bryant • July 6, 2018 -
Intermountain funds $12M collaborative SDOH effort
The Utah Alliance for the Determinants of Health is working with SelectHealth Medicaid members in Ogden and St. George.
By Les Masterson • July 5, 2018 -
Deep Dive
The boons of — and barriers to — behavioral health integration
An increasing number of clinics are trying a collaborative care model, but reimbursement, structural and historical barriers remain an obstacle.
By Les Masterson • July 5, 2018 -
Prior authorization limits would be 'reasonable' for CGRP drugs, ICER says
While Amgen won some credit for pricing its new migraine drug lower than expected, payers could still act as a gatekeeper for access to CGRP inhibitors.
By Ned Pagliarulo • July 5, 2018 -
Humana, private equity firms complete Kindred acquisition
The agreement separates Kindred into two companies, with Humana picking up a 40% share in Kindred at Home.
By Les Masterson • July 3, 2018 -
CMS proposes home health pay changes, including remote monitoring
The agency estimates the changes will save home health agencies $60 million in annualized costs beginning in 2020.
By Rebecca Pifer Parduhn • July 3, 2018 -
CMS: Unsubsidized ACA enrollment dropped 20% in 2017
The agency used new data to make their case that federal and state-based exchanges and state individual health insurance markets are in turmoil.
By David Lim • July 3, 2018 -
CMS pitches MA demo letting doctors avoid MIPS rules
Administrator Seema Verma said the pilot looks to "put Medicare Advantage on a more equal playing field with fee-for-service Medicare.”
By Les Masterson • July 2, 2018 -
Deep Dive
Return of the house call
Big systems like Johns Hopkins and CMS itself are increasingly looking to home-based care.
By Les Masterson • July 2, 2018 -
Judge strikes down Kentucky Medicaid work requirements
HHS Secretary Alex Azar "must adequately consider the effect of any demonstration project on the state’s ability to help provide medical coverage," U.S. District Judge James Boasberg wrote.
By Jeff Byers • July 2, 2018 -
Payment reform must keep patient equity in mind, consumer group says
A Families USA report urges shifting to a payment system that recognizes population health efforts, rewards value and addresses inequities.
By Les Masterson • July 1, 2018 -
Feds boast largest healthcare fraud takedown ever at $2B in false claims
The investigations included 84 opioid cases involving more than 13 million illegal doses.
By Meg Bryant • June 29, 2018 -
Bind Benefits trying on-demand coverage for health insurance
The 2-year-old startup is backed by Ascension Ventures, Lemhi Ventures and UnitedHealthcare.
By Meg Bryant • June 29, 2018 -
CareFirst touts $1B saved with patient-centered medical home program
The model has been running for eight years and has more than 4,300 participating primary care providers.
By Rebecca Pifer Parduhn • June 29, 2018 -
CMS clears Medicaid value-based drug state plan, denies closed formulary
The agency also made clear that drugs approved by the FDA under its accelerated approval pathway must be covered by state Medicaid programs if they are defined as a "covered outpatient drug."
By David Lim • June 28, 2018 -
CMS looking for chief health informatics officer
The agency is seeking someone to lead its health IT and interoperability efforts and serve as a liaison with industry stakeholders.
By Meg Bryant • June 28, 2018 -
Most healthcare organizations polled ready for value-based care
The HealthLeaders Media report also found many companies lack the necessary infrastructure to make payment model changes.
By Les Masterson • June 28, 2018 -
Amazon to acquire online pharmacy PillPack
Amazon said the deal will help it enter the pharmacy space. Experts had warned that barriers to entry were daunting challenges, but acquiring PillPack may solve some of those problems.
By David Lim • June 28, 2018 -
Cerner's VA go-live expected in 2020
Lawmakers worry a lack of stable leadership and transparency at the VA could undermine implementation of the $16 billion project.
By Meg Bryant • June 28, 2018 -
Mayo, BCBS deal includes downside risk, prior authorization limits
The five-year contract calls for a collaborative governance structure that would guide care for organ transplants, radiation therapies and genomics.
By Les Masterson • June 28, 2018 -
CMS to step up scrutiny of state Medicaid programs
MLR audits will focus on states "based on the amount spent on clinical services and quality improvement versus administration and profit."
By David Lim • June 27, 2018
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