JAMA: Admin costs vary by type of visit

The researchers said their findings could be used to inform policies that reduce administrative costs.

By Les Masterson • Feb. 20, 2018

UPDATE: CMS seeks expansion of short-term plans to sidestep ACA

HHS acknowledges that the exodus of young and healthy exchange members could contribute to rising premiums within the ACA exchange markets.

By Jeff Byers , David Lim • Feb. 20, 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

Healthcare industry 'ripe for disruption,' S&P Global warns

Segments considered most vulnerable include medical and lab supplies, healthcare e-commerce and retail pharmacies.

By Meg Bryant • Feb. 16, 2018

Anthem makes exceptions to controversial ER policy

In the six states where Anthem denies ER claims it later deems unnecessary, patients who receive treatment on a weekend or receive certain services, for example, are now exempt. 

By Shannon Muchmore • Feb. 16, 2018

CMS to watch and wait on Idaho Blue Cross's ACA-skirting plans

HHS Secretary Alex Azar told lawmakers the department would look at the health plans and measure them against ACA requirements once it receives a waiver request from the insurer.

By David Lim • Feb. 16, 2018

Georgia hospitals sue Anthem over ER, imaging policies

Anthem will shortly stop paying for imaging in hospitals and for emergency department care that it later deems not an emergency.  

By Les Masterson • Feb. 15, 2018

Healthcare spending to reach 19.7% of GDP within a decade

Hospital care spending growth is expected to increase 5.5% on average between 2017 and 2026, the report finds.

By Jeff Byers • Feb. 14, 2018

Reducing healthcare costs not one-size-fits-all, report finds

The Network for Regional Healthcare Improvement analyzed healthcare costs for five states and found huge differences in terms of costs and drivers.

By Les Masterson • Feb. 14, 2018

Aetna prior authorization probed by 2 states

A former medical director said he didn't review patient medical records when deciding on authorization, but instead relied on Aetna nurses' guidance.  

By Les Masterson • Feb. 14, 2018

Survey: 80% of payers taking steps to address social determinants of health

Healthcare leaders now see high deductible health plans as a negative incentive with little effect in changing consumer behavior.

By Meg Bryant • Feb. 14, 2018

Most healthcare execs say value-based programs led to positive financial results

A Healthcare Financial Management Association survey also said commercial payers haven’t rolled out value-based programs as quickly as expected.  

By Les Masterson • Feb. 14, 2018

Hospitals performed small amount of cost-shifting, study finds

Recent research found that hospitals negotiated 1.5% higher average private payer reimbursements to offset cuts from public payers.

By Les Masterson • Feb. 13, 2018

Molina posts $269M Q4 loss after turbulent year

Molina Healthcare went through major changes in 2017, including removing its CEO-president and CFO. 

By Les Masterson • Feb. 13, 2018

Kaiser 2017 revenue up 11%, buoyed by Group Health buy

Total operating revenue was $72.2 billion in 2017.

By Jeff Byers • Feb. 12, 2018

Trump budget slashes Medicaid, targets 340B

The proposal is more a political document than anything else, but HHS Secretary Alex Azar said it addresses priorities including a push toward paying for value.

By Shannon Muchmore , David Lim • Feb. 12, 2018

More oversight for 340B needed, White House council says

The Council of Economic Advisers suggested creating an independent agency to oversee the prescription payment program.  

By Les Masterson • Feb. 12, 2018

GAO: Medicare cost-sharing update would involve trade-offs

Capping beneficiary out-of-pocket costs could reduce demand for supplemental insurance, the agency said.

By Meg Bryant • Feb. 9, 2018

ACA enrollment fell overall, but ticked up in state-run exchanges

The figures don't tell the whole story, however. The 2018 numbers were expected to fall well below previous signups after the Trump administration spent the past year trying to dismantle the ACA.

By Les Masterson • Feb. 9, 2018

3 reasons evidence-based policy is hard

Academics and policymakers gave advice on the challenges to making evidence-based policy at a recent healthcare conference.

By Shannon Muchmore • Feb. 9, 2018

Smorgasbord of health items in massive 2-year budget deal

The agreement staving off an extended government shutdown includes a delay to Disproportionate Share Hospital payment cuts, a repeal of the ACA's Independent Payment Advisory Board and more funding to fight the opioid crisis.

By David Lim • Feb. 9, 2018

Judge rejects whistleblower lawsuit involving Epic billing software

The case was brought by a former compliance review specialist at WakeMed Health.

By Meg Bryant • Feb. 8, 2018

CVS easily beats Q4 forecast, sees Aetna deal on track

CEO Larry Merlo said on an earnings call "nothing that has surfaced" on the Aetna merger bid has come as a surprise, and he still expects the deal to close in the second half of this year.

By David Lim • Feb. 8, 2018

Kansas considers telehealth parity bill

The bill, introduced last month, has strong support from providers and insurers in the state.

By Meg Bryant • Feb. 7, 2018

Management organizations can play key role in ACOs

A Health Affairs report found partnerships helped providers in ACOs with data, administrative, educational and care coordination services.

By Les Masterson • Feb. 7, 2018

Express Scripts: Plan drug spending rose at slowest rate in 24 years

The PBM says its efforts to rein in rising drug costs have helped the plans it administers secure hundreds of millions in savings last year.

By Ned Pagliarulo • Feb. 7, 2018