Payer: Page 132
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Deep Dive
Providers go deeper with population health, weighing social factors
Healthcare organizations are waking up to the importance of social determinants of health, like housing and nutrition.
By Les Masterson • Jan. 22, 2018 -
Bruce Bennett via Getty Images
Shareholder sues Aetna to block CVS deal
The lawsuit claims Aetna's SEC filing for a proposed agreement with CVS included “materially incomplete and misleading information."
By Les Masterson • Jan. 18, 2018 -
Pharma, payers clash over CMS Part D drug rebate plan
The drug, pharmacy benefit managers and insurance industries are squabbling over a CMS proposal to require Part D sponsors to pass on a percentage of rebates to consumers.
By David Lim • Jan. 18, 2018 -
Hospitals, payers and docs collaborate on prior authorization
Trade groups for major healthcare players say they share a "commitment to industry-wide improvements to prior authorization processes and patient-centered care."
By Les Masterson • Jan. 17, 2018 -
Uninsured rate in 2017 had biggest increase in a decade
The rate increased in all demographic groups except for senior citizens, but went up most for young adults, blacks, Hispanics and low-income Americans.
By Les Masterson • Jan. 17, 2018 -
CBO analyzes pricing disparities between physician services, Medicare
The agency compared the prices three major insurers paid for common services against Medicare's fee-for-service program. The difference is substantial.
By Tony Abraham • Jan. 16, 2018 -
Getty / Edited by Healthcare Dive
UnitedHealth Group earnings up in Q4, hikes forecast due to tax bill
Jeff Alter, CEO of UnitedHealthcare Employer & Individual, pointed to the potential impacts of the ACA's health insurance tax, saying consumers will see much higher premiums if the tax is not delayed or repealed.
By Jeff Byers , David Lim • Jan. 16, 2018 -
Kentucky first to try Medicaid work requirement
Allowing states to require work is one way the Trump administration is looking to reduce the size of Medicaid.
By Les Masterson • Jan. 15, 2018 -
Deep Dive
Trump admin's new bundle bid shows value-based care's staying power
Advocates of value-based payment reform breathed a sigh of relief last week when CMS announced a new bundled payment model.
By Shannon Muchmore • Jan. 12, 2018 -
Worldwide ambulance market to reach $48.9B by 2025
Advanced life-support ambulance services are expected to dominate the market over the next eight years.
By Meg Bryant • Jan. 12, 2018 -
FDA lays out digital health goals in 2018 strategic roadmap
The agency will continue to build out its Pre-Certification Pilot Program to help encourage the development of digital health tools.
By David Lim • Jan. 12, 2018 -
Lawsuit accuses Centene of misleading customers on narrow ACA plans
The allegations against Centene come as the Trump administration is moving toward narrower networks in ACA exchanges.
By Meg Bryant • Jan. 12, 2018 -
CMS goes all in on Medicaid work requirements
At least ten states are considering section 1115 Medicaid waivers that require enrollees to have a job, train for a job or participate in community activities like volunteer work.
By Shannon Muchmore • Jan. 11, 2018 -
ACOs flock to Medicare Shared Savings Program
Most of the ACOs in a risk-based contract chose Track 1+, which is the latest risk model.
By Les Masterson • Jan. 11, 2018 -
CMS extends Maryland all-payer program for another year
Maryland is working with the agency on a larger proposal to include outpatient services.
By Les Masterson • Jan. 10, 2018 -
Payers with ACA plans expected to have relatively strong year
Experts predict a fairly stable 2018 for the individual market, as long as Congress doesn't try another "repeal and replace" effort or make more moves that might destabilize the exchanges.
By Les Masterson • Jan. 10, 2018 -
CMS launches new, voluntary bundled payment model
The Bundled Payments for Care Improvement Advanced program will be considered an advanced alternative payment model for the purposes of MACRA reporting.
By Shannon Muchmore • Jan. 10, 2018 -
Azar talks list prices, mandatory Medicare pilots
The nominee for HHS secretary identified high drug prices and shifting payment models to reward health outcomes as among his top priorities.
By David Lim • Jan. 9, 2018 -
Deep Dive
Could narrow networks be the next big cost cutter?
Narrow provider networks can mean lower costs, but also less flexibility for members and likely lower patient satisfaction.
By Les Masterson • Jan. 9, 2018 -
Health Affairs: Ending Medicaid expansion would cause rural hospitals to go under
Researchers found Medicaid expansion improved hospital finances and meant a substantially lower chance that hospitals — especially rural facilities — closed.
By Les Masterson • Jan. 9, 2018 -
GAO: CMS must improve state-reported data collection for Medicaid
“CMS has taken steps for the initial use of T-MSIS data, but does not have a plan or associated timeframes for using these data for oversight,” GAO said.
By Les Masterson • Jan. 9, 2018 -
Amino pitches new HSA amid growth in high deductibles
The company is betting that high deductibles and better education over HSAs will incite greater utilization.
By Jeff Byers • Jan. 8, 2018 -
CBO: Needed CHIP funding drastically reduced due to individual mandate repeal
The Senate bill that would reauthorize CHIP would increase the deficit by $0.8 billion over 2018-2027 rather than the Congressional Budget Office and the Joint Committee on Taxation's previous $8.2 billion estimate.
By David Lim • Jan. 8, 2018 -
Avalere: Value-based care movement will overcome speed bumps this year
The annual report predicted a year full of changes to the healthcare system, including additional attempts to repeal the ACA, mergers and technological changes.
By Les Masterson • Jan. 8, 2018 -
More time may not help hospitals achieve P4P value, study says
Researchers compared clinical process scores and 30-day mortality rates for hospitals that began value-based programs in 2003 and a group that began in 2011.
By Meg Bryant • Jan. 5, 2018
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