CVS, Aetna go to Congress to defend proposed merger

CVS is expected to argue that the merger will allow for better-integrated patient care by enabling pharmacists, equipped with both prescription and medical information, to play a bigger role between physician visits.

By David Lim • Feb. 27, 2018

Moody's: Aggressive insurer growth strategies threaten nonprofit hospitals

The embrace of value-based payment models is shifting more patients to cheaper outpatient settings, the ratings agency said.

By Meg Bryant • Feb. 23, 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

Anthem rescinds same day service cut, AMA says

It's a win for the AMA and other providers that protested the E/M cut planned for 14 states. Anthem had already reduced the cut from 50% and delayed the onset for two months.

By Shannon Muchmore • Feb. 23, 2018

High deductible plan use jumps since 2010, now at 43%

The National Center for Health Statistics also said the percentage of uninsured Americans in 2017 remained about the same as the previous year.

By Les Masterson • Feb. 23, 2018

Flawed evaluation of Medicaid demonstrations limits policy impact, GAO says

The government watchdog looked at state evaluations of Medicaid demonstrations in three states and found shortcomings in each of them.

By Meg Bryant • Feb. 23, 2018

Trump short-term health plan may spur more ACA exits

The impact of the individual mandate repeal and higher premiums could inflate a shift out of ACA plans.

By David Lim • Feb. 23, 2018

Community health center patients more likely to cite housing struggles, JAMA reports

People who can’t rely on steady housing will likely have difficulties staying on top of their health, adhering to medication and making appointments.  

By Les Masterson • Feb. 22, 2018

Anthem to limit anesthesiologists in latest cost-saving move

Critics of the policy say it will force cataract surgery patients to pay for the service themselves or face higher risks.

By Les Masterson • Feb. 21, 2018

Express Scripts joins Walgreens Boots to cut biosimilar costs

The pharmacy benefit manager is expanding its agreement with the drug store giant to simplify the supply chain for specialty pharmaceuticals. 

By Lisa LaMotta • Feb. 21, 2018

Anthem's cost-cutting drive riles providers

The payer said the E/M payment cut is one way to reduce costs for its members and employer clients, but critics say the change may require patients to return for another doctor visit. 

By Les Masterson • Feb. 21, 2018

JAMA: Admin costs vary by type of visit

The researchers said their findings could be used to inform policies that reduce administrative costs.

By Les Masterson • Feb. 20, 2018

UPDATE: CMS seeks expansion of short-term plans to sidestep ACA

HHS acknowledges that the exodus of young and healthy exchange members could contribute to rising premiums within the ACA exchange markets.

By Jeff Byers , David Lim • Feb. 20, 2018

Healthcare industry 'ripe for disruption,' S&P Global warns

Segments considered most vulnerable include medical and lab supplies, healthcare e-commerce and retail pharmacies.

By Meg Bryant • Feb. 16, 2018

Anthem makes exceptions to controversial ER policy

In the six states where Anthem denies ER claims it later deems unnecessary, patients who receive treatment on a weekend or receive certain services, for example, are now exempt. 

By Shannon Muchmore • Feb. 16, 2018

CMS to watch and wait on Idaho Blue Cross's ACA-skirting plans

HHS Secretary Alex Azar told lawmakers the department would look at the health plans and measure them against ACA requirements once it receives a waiver request from the insurer.

By David Lim • Feb. 16, 2018

Georgia hospitals sue Anthem over ER, imaging policies

Anthem will shortly stop paying for imaging in hospitals and for emergency department care that it later deems not an emergency.  

By Les Masterson • Feb. 15, 2018

Healthcare spending to reach 19.7% of GDP within a decade

Hospital care spending growth is expected to increase 5.5% on average between 2017 and 2026, the report finds.

By Jeff Byers • Feb. 14, 2018

Reducing healthcare costs not one-size-fits-all, report finds

The Network for Regional Healthcare Improvement analyzed healthcare costs for five states and found huge differences in terms of costs and drivers.

By Les Masterson • Feb. 14, 2018

Aetna prior authorization probed by 2 states

A former medical director said he didn't review patient medical records when deciding on authorization, but instead relied on Aetna nurses' guidance.  

By Les Masterson • Feb. 14, 2018

Survey: 80% of payers taking steps to address social determinants of health

Healthcare leaders now see high deductible health plans as a negative incentive with little effect in changing consumer behavior.

By Meg Bryant • Feb. 14, 2018

Most healthcare execs say value-based programs led to positive financial results

A Healthcare Financial Management Association survey also said commercial payers haven’t rolled out value-based programs as quickly as expected.  

By Les Masterson • Feb. 14, 2018

Hospitals performed small amount of cost-shifting, study finds

Recent research found that hospitals negotiated 1.5% higher average private payer reimbursements to offset cuts from public payers.

By Les Masterson • Feb. 13, 2018

Molina posts $269M Q4 loss after turbulent year

Molina Healthcare went through major changes in 2017, including removing its CEO-president and CFO. 

By Les Masterson • Feb. 13, 2018

Kaiser 2017 revenue up 11%, buoyed by Group Health buy

Total operating revenue was $72.2 billion in 2017.

By Jeff Byers • Feb. 12, 2018

Trump budget slashes Medicaid, targets 340B

The proposal is more a political document than anything else, but HHS Secretary Alex Azar said it addresses priorities including a push toward paying for value.

By Shannon Muchmore , David Lim • Feb. 12, 2018