Payer: Page 123
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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 -
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 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 -
Getty / Edited by Healthcare Dive
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 -
Industry group offers roadmap to greater provider directory accuracy
One of the first challenges is defining who is and is not a provider, according to a CAQH white paper.
By Meg Bryant • May 31, 2018 -
Deep Dive
Days of information blocking look numbered
Government pressure and emerging business incentives are encouraging companies to share data.
By Meg Bryant • May 31, 2018 -
Healthcare groups mixed on proposed direct provider contracting model
Some groups support DPC as a way to increase access to alternative payment models, but others fear it is too redundant and encouraged CMS to fix other programs instead.
By Les Masterson • May 30, 2018 -
Virginia on cusp of expanding Medicaid
The state Senate on Wednesday moved past the most significant hurdle to expand Medicaid to an additional 400,000 residents, a long-sought goal of Democrats using the powers under the Affordable Care Act.
By David Lim • Updated May 31, 2018 -
Readmission rates among BPCI episodes show room for improvement
Groups mulling participation in the Bundled Payment for Care Improvement Advanced model may find success in targeting certain high readmission rates, according to a new report from Avalere.
By Shannon Muchmore • May 30, 2018 -
WellCare to acquire Meridian for $2.5B
The deal, expected to close by the end of the year, will boost WellCare's presence in the growing Medicare Advantage market.
By Tony Abraham • May 30, 2018 -
ACA health insurance tax would be delayed 2 years under bipartisan bill
Insurance companies say ending the tax would let them reduce premiums by 3%.
By Les Masterson • May 29, 2018 -
Medicaid expansion sees movement in Virginia, may get vote in Idaho
Virginia could become the next state to expand Medicaid, with the state legislature expected to vote in the coming days on a plan that would tax hospitals to fund the added coverage.
By Les Masterson • May 29, 2018 -
CMS plugs Medicare Advantage in beneficiary handbook draft
A version of next year's guide, which hasn't yet been published, also subtly encourages people in MA plans to request prior authorization for services and supplies.
By Meg Bryant • May 25, 2018 -
California to hospitals: 'Time's up' on unnecessary procedures
Covered California is threatening to oust hospitals with high C-section rates from participating health plans' provider networks.
By Meg Bryant • May 25, 2018 -
Integrating behavioral health, primary care can save money
A Colorado program saved more than $1 million by creating a risk-adjusted payment system for practices that had on-site behavioral health providers.
By Les Masterson • May 25, 2018 -
Comments criticize CMS plan to cut Medicaid care access monitoring
Healthcare officials said the change could especially hurt rural hospitals and force facilities to take lower rates without any recourse.
By Les Masterson • May 24, 2018 -
CMS primary care model slowed ED visits, but did not cover costs
A new study found no significant differences between participants in the Comprehensive Primary Care Initiative and comparison practices when examining spending growth.
By David Lim • May 24, 2018 -
Payers should rethink Medicare Advantage marketing, report suggests
Accenture Consulting said insurers risk millions in revenue by not taking into account how many people wait until after 65 to enroll in Medicare.
By Les Masterson • May 23, 2018 -
Trump pricing plan could lead to higher patient costs, Avalere suggests
The consultancy says a proposal to move drugs from Medicare Part B to Part D could end up costing cancer patients more out of pocket.
By Lisa LaMotta • May 23, 2018 -
Hospitals could save millions on hip, knee implants
Optimizing use of anesthesia and bone cement, along with streamlining workflow, could cut costs for the expensive procedures, a Premier report found.
By Les Masterson • May 23, 2018 -
Anthem to acquire palliative care provider Aspire Health
The deal is expected to close in the third quarter of this year. Terms were not disclosed.
By Jeff Byers • May 23, 2018 -
Sponsored by Studer Group
Breathing Room: 3 powerful ways to respond to today's financial squeeze
Learn 3 strategies from a healthcare CEO for responding to financial pressures.
May 23, 2018 -
California plan would provide Medicaid to undocumented adults
The plan could cost as much as $3 billion in 2018 and 2019.
By Les Masterson • May 22, 2018 -
CMS should extend prior authorization pilots, GAO says
The handful of Medicare prior authorization programs saved an estimated $1.1 billion to $1.9 billion through March 2017, according to a new report.
By Shannon Muchmore • May 22, 2018
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