Payer: Page 126
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CMS mum on restricting how payers use subsidies
Insurers that offer ACA plans often use the practice of "silver loading," which involves putting all the losses associated with the end of CSR payments on only silver plans.
By Les Masterson • March 26, 2018 -
Deep Dive
Payers use data to flag those at greatest risk of opioid abuse
The idea is to pinpoint patients most likely to become addicted and help prevent opioid abuse before it starts.
By Les Masterson • March 26, 2018 -
Most employers short of tipping point for health coverage
The American Health Policy Institute predicted employers won't be rushing to drop health insurance as a benefit, but some will go that route in the face of unmanageable healthcare costs.
By Les Masterson • March 26, 2018 -
CMS proposes to reduce state Medicaid requirements for monitoring access
The proposed rule is part of the Trump administration's drive to cut administrative red tape.
By Meg Bryant • March 23, 2018 -
Centene fined $100K for not fixing provider network inadequacies
The Washington state insurance commissioner says the payer has not adhered to its compliance plan following a $1.5 million fine last December.
By David Lim • March 23, 2018 -
Millennials more likely to use walk-in clinics, telemedicine, survey shows
Young people are shopping around more for providers and health plans, and are using online tools to support decision-making.
By Meg Bryant • March 23, 2018 -
EHR revamp from CMS lacks concrete path to implementation, Joe Biden says
The former VP’s suggestions include automatically sharing data with patients and alerting patients when they qualify for a clinical trial.
By Meg Bryant • March 22, 2018 -
ACA plan premium changes varied widely
Large premium hikes were connected to marketplace uncertainty, policy changes and payers dropping out of the exchanges, according to the Urban Institute.
By Les Masterson • March 22, 2018 -
Highmark Health's provider arm has best ever operating performance year
The company said its ACA plans were also profitable for the first time in 2017.
By Les Masterson • March 21, 2018 -
White House report targets health insurer profitability
The Council of Economic Advisers report argues many insurance companies' net profit margins have returned to pre-ACA levels on the backs of taxpayers.
By David Lim • March 21, 2018 -
HHS makes case against hospitals' 340B suit in new filing
"Setting aside the final rule for 2018 would direct payments away from these other services while creating administrative havoc in the OPPS system," HHS argued in a court filing this week.
By David Lim • March 21, 2018 -
Urgent care claims skyrocket; ER claims pale in contrast
A new FAIR Health analysis of more than 25 billion privately billed healthcare claims found large differences in growth depending on the place of service.
By Les Masterson • March 21, 2018 -
Blues plans made money in individual market last year
Payers still face an uncertain 2018 and 2019 in the ACA exchanges.
By Les Masterson • March 20, 2018 -
Maryland's all-payer model saved Medicare millions in first 3 years
A review of the state program found that it's on track to meet CMS-imposed targets for savings and patient safety.
By Les Masterson • March 19, 2018 -
CMS finalizes coverage of DNA sequencing for cancer patients
The agency will cover similar tests approved by the FDA.
By Jeff Byers • March 19, 2018 -
Trump to pitch national PDMP to fight opioid crisis
The president will visit New Hampshire to announce a slate of proposals, including calling for legislation to allow Medicaid to reimburse residential treatment at facilities with more than 16 beds.
By David Lim • March 19, 2018 -
Alex Wong via Getty Images
CMS plans MACRA changes to ease burden
CMS is expected to add more alternative payment models and is hoping to automatically receive quality data from EHRs rather than physicians reporting the data.
By Les Masterson • March 19, 2018 -
AMA survey says prior authorizations hurting clinical outcomes
Nearly one-third of physicians said they needed to wait at least three business days for a prior authorization decision, and doctors say the payer requests are rising.
By Les Masterson • March 19, 2018 -
Docs more likely to prescribe opioids after pharma pay, study finds
Opioid manufacturers paid physicians more than $43 million over a two-year period, according to CareDash.
By Meg Bryant • March 16, 2018 -
Reducing inappropriate joint replacements could save billions
Lack of patient education, variation in device prices and use of inpatient versus outpatient settings help fuel unnecessary costs around these procedures, according to a viewpoint in JAMA.
By Meg Bryant • March 16, 2018 -
ACA stabilization bills may become part of spending package
The Congressional Budget Office said resurrecting CSR payments could reduce premiums and increase the number of insured Americans.
By Les Masterson • March 16, 2018 -
CMS star ratings biased towards specialty hospitals, analysis suggests
Specialty hospitals reported fewer measures than major teaching hospitals, and frequently omitted mortality data.
By Meg Bryant • March 16, 2018 -
340B accountability under fire at Senate panel
The hearing comes as drugmakers point fingers at hospitals and other players involved in the drug pricing system.
By David Lim • March 15, 2018 -
BCBS joins with Lyft, CVS and Walgreens in new pop health effort
The payer is looking to address "transportation and pharmacy deserts" in test markets.
By Les Masterson • March 15, 2018 -
Hospitals acquired 5K physician practices in 1-year period
The report concluded that physicians struggle to maintain independent practices because payer policies "increasingly favor integrated health systems."
By Shannon Muchmore • March 14, 2018
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