Pop health programs not seeing expected growth, survey finds

The third annual report from Numerof & Associates calls into question whether healthcare organizations are ready to take on risk.

By Les Masterson • April 10, 2018

California bill would create healthcare price controls

The proposal would authorize an independent commission to set private health plan prices based on what Medicare pays for those services.

By Meg Bryant • April 10, 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

States get more power over ACA essential health benefits with final rule

The sweeping rule is the latest in the Trump administration’s steady chipping away at the landmark health law, which has been coupled with a move to give states more control over their healthcare regulations.

By Jeff Byers • April 9, 2018

Medicare to pay hundreds of thousands for CAR-T therapies

CMS will give hospitals outpatient reimbursements of about $400,000 for Gilead's Yescarta and $500,000 for Novartis' Kymriah.

By Jacob Bell • April 6, 2018

Opioid prescriptions down while addiction, overdose costs rise

The Kaiser Family Foundation looked at claims data for large employers between 2004 and 2016 to examine treatment costs from the opioid crisis.  

By Les Masterson • April 6, 2018

MedPAC approves plan to cut payments for some stand-alone EDs

AHA said the proposal is "unfounded" and would exacerbate Medicare's "record underpayment of outpatient departments."

By Tony Abraham • April 6, 2018

BCBS of Massachusetts cherry picks digital health tools for new platform

Two diabetes management apps and a fertility and pregnancy tool will be included.

By Meg Bryant • April 5, 2018

Surgeon General: More people should carry naloxone

The advisory comes a week before Congress is set to consider two competing packages aimed at curbing the opioid crisis.

By David Lim • April 5, 2018

Lafayette General threatens to shutter hospital amid budget impasse

LGH said that without funding either Louisiana State University will have to take over University Hospitals & Clinics again or the health system will close the hospital and lay off its employees on July 1.  

By Les Masterson • April 5, 2018

ACA plans expanded coverage for chronic conditions

Repeal of the individual mandate penalty, which goes into effect next year, will likely put the burden on states to figure out how to stabilize the ACA exchanges.  

By Les Masterson • April 4, 2018

Medicaid FFS biggest factor in billing headaches, report finds

A Health Affairs study found that there are more challenged claims with traditional Medicaid than involving other payers. Also, Medicaid payments take longer to process than others, including Medicare.  

By Les Masterson • April 4, 2018

Insurers bracing to hike premiums in 2019 and beyond

Despite worries about the individual market, consumers may not be running for the exits just yet.

By David Lim • April 4, 2018

Humana, Optum pilot blockchain to fix network lists

MultiPlan, UnitedHealthcare and Quest Diagnostics are also part of the initiative to use blockchain to ensure accuracy of network directories.

By Meg Bryant • April 3, 2018

Study finds 'pervasive' income disparities in pediatric hospitalizations

The report suggests that hospitals should spend more time on inpatient to outpatient transitions and on population health.

By Meg Bryant • April 3, 2018

Payers get better-than-expected Medicare Advantage rate increase

CMS also increased the role encounter data will play in determining risk scores and announced policies to target opioid abuse.  

By Les Masterson • April 3, 2018

Medicare ACOs missing federal cost-savings predictions, analysis finds

The finding raises questions about the long-term success of the Medicare Shared Savings Program, which has swelled to 561 ACOs from 27 six years ago.

By Meg Bryant • April 2, 2018

NQF report finds gaps in post-acute, long-term care measures

The report suggests a need for bidirectional measures that hold both referring providers and nursing homes accountable for care.

By Meg Bryant • April 2, 2018

States need more rules to protect individual insurance market

Changes made by the federal government may further destabilize the ACA exchanges, a new Commonwealth Fund report said.  

By Les Masterson • April 2, 2018

Walmart reportedly in early talks to acquire Humana

The companies already partner on Medicare Part D drug plans, but a deal, floated in the WSJ, could boost Humana's group market offerings to compete with other major insurers, a Mercer consultant suggests.

By David Lim • April 2, 2018

Oscar Health raises $165M from investors

The payer said profitability is "around the corner," but the ACA market it focuses on has not been lucrative for insurers and faces a potentially unstable future.  

By Les Masterson • March 29, 2018

GE, Medtronic among those linking with hospitals for value-based care

Manufacturers are putting their money where their mouth is — tying payment to real outcomes.  

By Meg Bryant • March 29, 2018

Healthcare M&A leading to higher prices in California

A University of California, Berkeley study said northern California pays much higher healthcare prices than the southern part of the state.  

By Les Masterson • March 28, 2018

Geisinger to build, co-own hospital with St. Luke's

The two systems work together frequently, including an insurance collaboration and an upcoming partnership that will see Geisinger providing St. Luke's with an emergency helicopter service.

By Tony Abraham • March 28, 2018

AHA argues HHS religious freedom rule unnecessary

The hospital group is also concerned that the proposed rule may endanger federal reimbursement if OCR takes action against a provider.

By David Lim • March 28, 2018

UnitedHealth countersues feds in $1B MA suit

UnitedHealth asks for the government's lawsuit be dismissed with prejudice and seeks relief "in an amount to be determined at trial."

By David Lim • March 28, 2018