Payer: Page 126
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Humana announces maternity bundled model for low- and mid-risk pregnancies
The new initiative is the payer's second specialty care payment model. A total joint replacement program is now available at about 40 orthopedic practices in 13 states.
By Meg Bryant • April 19, 2018 -
Pushing 'value,' Harvard Pilgrim tests outcomes deals
An agreement with AstraZeneca for the pharma's lung drug Symbicort is the ninth value-based contract publicly announced by the regional insurer.
By Ned Pagliarulo • April 19, 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 -
Potential Medicare APM overlap an increasing concern
Competing payment models in the same area "may have far-reaching impact on provider incentives and behavior," the authors of a recent Health Affairs blog post said.
By Les Masterson • April 19, 2018 -
Illinois stops Medicaid enrollment to state's BCBS
The state sanctioned the payer’s Medicaid managed care plan after it reportedly didn't meet patient access guidelines.
By Les Masterson • April 19, 2018 -
Healthcare megadeals may have major long-term impact, Moody's says
Payer vertical integration could put more pressure on hospital volumes and margins, according to a new report.
By Les Masterson • April 18, 2018 -
3 states could have Medicaid expansion on the ballot
Meanwhile, Arizona is requesting a waiver to stop Medicaid recipients from getting retroactive coverage up to three months before a person applies for coverage.
By Les Masterson • April 18, 2018 -
Healthcare sharing ministries: 5 things to know
These alternatives to regular health insurance have grown to nearly 1 million people this decade.
By Les Masterson • April 18, 2018 -
Alex Wong via Getty Images
Insurers argue HHS must clamp down on dialysis patient steering
Payers and a major union group said CMS should reissue its rule on steering in the individual market to prohibit financially interested third parties from making insurance payments.
By David Lim • April 18, 2018 -
Sampling suggests nearly a third of Medicare telehealth payments are improper
Most of the errant claims the HHS Office of Inspector General reviewed were due to care being provided in nonrural locations.
By Meg Bryant • April 17, 2018 -
ACA increased primary care usage, but also some risky behaviors, report finds
All of the gains in preventive care were driven by expansions in private insurance, according to the National Bureau of Economic Research paper.
By Meg Bryant • April 17, 2018 -
New APM seeks to improve opioid disorder treatment
The AMA and the American Society of Addiction Medicine have unveiled the Patient-Centered Opioid Addiction Treatment advanced payment model, which looks to improve care coordination.
By Les Masterson • April 17, 2018 -
Getty / Edited by Healthcare Dive
UnitedHealth sees membership, revenue up in Q1
David Wichmann, CEO of UnitedHealth Group, predicted half of Americans will get care from a physician with a value-based contract within a decade.
By Les Masterson • April 17, 2018 -
Amazon reportedly drops plan to distribute pharmaceuticals to hospitals
The report is not entirely unexpected. Amazon in December canceled its pharmaceutical wholesaler application in Maine and told state regulators it did not intend to sell drugs.
By David Lim • April 17, 2018 -
Bruce Bennett via Getty Images
CVS hires Iora Health's CMO to run MinuteClinic
The CVS-brand clinics will likely play a key role if the company's proposed $69 billion merger with Aetna gets regulatory approval.
By Les Masterson • April 16, 2018 -
Pricey cholesterol drugs appear to meet less payer resistance
A new report finds the nation's largest health plans ultimately denied 26% of claims for the cholesterol-lowering drugs in 2017 — a lower rate than before.
By Jacob Bell • April 16, 2018 -
New Jersey moves closer to its own individual mandate
The state legislature also approved a reinsurance program to help payers cover the sickest members. Both moves look to stabilize the individual market and ACA exchange.
By Les Masterson • April 16, 2018 -
Short-term plan expansion will hike individual market premiums, lower enrollment
The Trump administration wants to expand short-term plans, also known as catastrophic plans, to anyone and increase their duration from three months to one year.
By Les Masterson • April 13, 2018 -
Payer execs most concerned about member satisfaction
A new Healthedge survey found insurers are paying less attention to regulatory issues and moving to value-based payment models.
By Les Masterson • April 12, 2018 -
Getty / Edited by Healthcare Dive
Deep DiveOptum a step ahead in vertical integration frenzy
UnitedHealth's healthcare services arm is the elephant in the room as media darlings Amazon and Walmart look to enter the market.
By Jeff Byers • April 12, 2018 -
JAMA report finds wide health variations by state
Hawaii had the highest life expectancy at birth in 2016 (81.3 years) while Mississippi had the lowest (74.7 years).
By Les Masterson • April 12, 2018 -
CVS gives pharmacists, doctors tools to cut drug spending
The pharmacy giant is working with EHR vendors like Epic to give providers real time patient formulary information to keep costs down.
By Ned Pagliarulo , David Lim • April 12, 2018 -
Deep Dive
The VA privatization debate: 5 things to know
As the nominee for VA secretary awaits his confirmation hearing, debate is heating up over how involved healthcare's private sector should be in the second-largest federal agency.
By Tony Abraham • April 11, 2018 -
UnitedHealthcare seeks arbitration to resolve Envision contract dispute
The payer has taken aim at Envision and even added a page to its website that names the company as a reason for "outsourced ERs" and higher ER costs.
By Les Masterson • April 11, 2018 -
Medicaid improves access, preventive services, AHIP report says
The study comes as Virginia considers becoming the 34th state to expand Medicaid under the ACA.
By Les Masterson • April 11, 2018 -
Medicare Advantage gets supplemental benefits flexibility, including for transport
The change opens the door to benefits not directly related to healthcare, such as meal delivery and ride-hailing services like Lyft.
By Meg Bryant • April 10, 2018
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