Fitch says Medicaid cost growth likely to force states to cut programs

The ratings agency reported that healthcare costs for states have increased more than $300 billion since 2005, and will only grow in the next decade.

By Les Masterson • June 14, 2018

Federal appeals court denies insurers billions in risk corridor payments

In the lawsuit brought by Moda Health, the court ruled the program "lacks the trappings of a contractual agreement."

By Tony Abraham • June 14, 2018

Medigap plans rise in popularity but coverage geographically sparse, AHIP says

A new report from the insurance lobby found more than 13 million beneficiaries have a Medigap plan.

By Les Masterson • June 13, 2018

New Medicare Advantage rules hold big potential for pop health

A CMS rule taking effect this week lets payers offer benefits like ride-hailing and nutrition support to boost health.

By Meg Bryant • June 13, 2018

FDA permits more expansive communication between drugmakers, payers

The move seeks to smooth adoption of value-based contracts, including clarity on what economic information or analyses drugmakers can share with payers about their products.

By Ned Pagliarulo • June 13, 2018

AMA, industry leaders call on CMS to expand remote patient monitoring reimbursement

The agency took a step toward broader remote monitoring reimbursement with the unbundling of CPT 99091 in the 2018 Physician Fee Schedule final rule.

By Meg Bryant • June 12, 2018

CMS sets goals to tackle opioid crisis

The plan calls for greater data transparency and interoperability and use of the Medicare heat map to pinpoint areas that can benefit from targeted safe prescribing efforts.

By Meg Bryant • June 12, 2018

CMS expands Maryland's all-payer program to outpatient services

The agency said the new model will save Medicare more than $1 billion by the end of 2023 and "creates new opportunities for a range of non-hospital healthcare providers to participate in this test to limit Medicare spending."

By Les Masterson • June 12, 2018

Anthem ED policy a sticking point in Indiana contract dispute

Saint Joseph Health System mailed a letter to patients warning they could soon face out-of-network costs if it does not agree to new terms with the payer by the end of the month.

By Les Masterson • June 12, 2018

Fixing provider directories a low-risk way to test blockchain, report suggests

UnitedHealth, Humana and Quest Diagnostics are among those working on a pilot blockchain project to update provider directories.

By Les Masterson • June 11, 2018

Geisinger's revenue, operating income up in first 9 months of FY 18

The health system attributed the growth to higher patient service and premium revenues.

By Meg Bryant • June 8, 2018

ED visits increased nearly 10% in California after ACA

A Health Affairs study also found the chance of a Medicaid enrollee being a frequent ED user was "significantly lower" after the Affordable Care Act was signed into law.

By Les Masterson • June 8, 2018

DOJ argues ACA pre-existing condition, individual mandates unconstitutional

The Trump administration said that with Congress zeroing out the penalty starting in 2019, the health law's individual mandate, community rating and guaranteed issue provisions cannot stand.

By David Lim • Updated June 8, 2018

Study raises concerns about Medicaid managed care's narrow networks

A Health Affairs report said states need to make sure that physician turnover in narrow network plans doesn't create issues with doctor continuity for vulnerable populations.

By Les Masterson • June 7, 2018

Bucking national trend, Pennsylvania payers seek modest exchange premium hikes

While many states worry there will be less competition in the individual market next year, Pennsylvania is seeing an uptick of participation in the exchange.

By Les Masterson • June 6, 2018

Medicaid expansion improved care access and coverage, analysis finds

More than 30 states have expanded Medicaid under the ACA, and a few more will have the issue up for a vote this fall.

By Les Masterson • June 6, 2018

Mandatory CMS bundles showed advantages over voluntary initiatives, report finds

A Health Affairs report found mandatory and voluntary bundled payment models "engaged different types of hospitals."

By Les Masterson • June 6, 2018

BCBS of Texas delays unnecessary ED visit policy

The Texas Department of Insurance requested the delay and questioned the payer on the new policy.

By Les Masterson • June 5, 2018

Payer-provider partnerships on record pace

So far this year, 22 alliances have been formed, with more than 90% using value-based reimbursement as a component.

By Les Masterson • June 4, 2018

Losing ACA mandate penalty will reverse coverage gains, report finds

A Brookings analysis that focused on those not eligible for ACA subsidies found the individual mandate was the major reason the group got insured.

By Les Masterson • June 4, 2018

Omission of observation stays in readmission measures misses key patient cohort, analysis suggests

The rate of 30-day readmissions for observation stays between 2007 and 2015 increased while inpatient readmissions declined, according to a New England Journal of Medicine paper.

By Meg Bryant • June 1, 2018

AMA trumpets physician efforts in opioid epidemic fight

The doctors' group said opioid prescriptions are down while prescription drug monitoring program queries are up.

By Les Masterson • June 1, 2018

Trump administration pushes 340B ceiling price rule to 2019

It is the fifth delay for the rule, which would also set a penalty for drugmakers that overcharge participating hospitals.

By Tony Abraham • June 1, 2018

UnitedHealth CEO predicts dramatic hike in value-based program participation

David Wichmann told investors that the payer is focused on using its care delivery arm to push patients who don’t need emergency care toward a more appropriate setting.

By Shannon Muchmore , Tony Abraham • June 1, 2018

Technology, value-based care driving M&A, report says

Buyers are looking for targets that can respond quickly to regulatory and market changes.

By Meg Bryant • May 31, 2018