Payer: Page 137
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JAMA: Ignoring 'social risk' can underpay doctors for at-risk populations
The study looked at the Massachusetts Medicaid program's social determinants of health payment model.
By Les Masterson • Aug. 8, 2017 -
Appeals court rules against former Medi-Cal payment cuts
The court ruled the federal government shouldn't have approved the 10% cut in 2008 without evidence it wouldn't affect access to care for members of the state Medicaid program.
By Les Masterson • Aug. 8, 2017 -
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 -
Healthcare leaders challenging Anthem's ED policy in Missouri
The payer recently announced it will no longer cover what it views to be unnecessary ED services in Missouri.
By Les Masterson • Aug. 8, 2017 -
Maine Medicaid waiver application includes work requirements, asset testing
The document states Maine is trying to “preserve limited financial resources,” but the proposal has many detractors among policy experts.
By Shannon Muchmore • Aug. 7, 2017 -
Evergreen Health CEO resigns after company is placed into receivership
A Baltimore judge recently placed Risk & Regulatory Consulting in charge of the company.
By Les Masterson • Aug. 7, 2017 -
Cigna latest major payer to post strong Q2
The insurer raised its 2017 earnings forecast from between $9.35 and $9.85 to between $9.75 and $10.05 per share.
By Les Masterson • Aug. 7, 2017 -
Molina wins $52M ACA risk corridor suit
The insurer is the second to win a risk corridor lawsuit this year.
By Jeff Byers • Aug. 7, 2017 -
Florida Medicaid managed care demonstration gets 5-year extension
The state's uncompensated care pool will receive about $1.5 billion annually, based on the most current data on hospitals’ charity care costs.
By Meg Bryant • Aug. 4, 2017 -
Evergreen Health goes into receivership
The court order follows the collapse of a plan to switch the insurance co-op to for-profit status
By Meg Bryant • Aug. 4, 2017 -
Montgomery County Planning Commission
Aetna raises outlook with Q2 earnings release
The payer's earnings report is the latest in a series of strong second-quarter results for large insurers.
By Les Masterson • Aug. 4, 2017 -
Study: Value-based programs may harm practices that 'disproportionately serve high-risk patients'
The study isn't the first to show value-based programs as a mixed bag.
By Les Masterson • Aug. 4, 2017 -
Accreditors won't have to share hospital error reports, CMS rules
The agency said it wants to review and refine the proposal to ensure it’s in line with federal law.
By Meg Bryant • Aug. 4, 2017 -
Molina posts $230M loss in Q2, eliminating 1.5K jobs
The company also announced it is pulling out of ACA exchanges in Utah and Wisconsin and scaling back participation in Washington state.
By Jeff Byers , Shannon Muchmore • Aug. 2, 2017 -
Deep Dive
Health reform driving payer-provider partnerships
A major driver of these partnerships is the move away from fee-for-service payments and toward valued-based payments and population health management.
By Les Masterson • Aug. 2, 2017 -
Humana beats Q2 earnings predictions thanks to Medicare Advantage
Despite beating its estimates, Humana’s revenue fell in the second quarter.
By Les Masterson • Aug. 2, 2017 -
Premiums in California ACA plans expected to increase 12.5%
About 10% of people who get coverage through Covered California will need to find a new insurance company because of Anthem pulling back on ACA plans.
By Les Masterson • Aug. 1, 2017 -
Montgomery County Planning Commission
Aetna sued for pulling out of ACA exchanges
In other ACA exchange news, the number of counties without an ACA exchange option in 2018 was cut in half after payers in Ohio agreed to offer plans in 19 formerly bare counties.
By Les Masterson • Aug. 1, 2017 -
Deep Dive
Trump's approach to opioid crisis worries experts
“There’s no question that the Medicaid cutbacks would be devastating” for the opioid crisis, Johns Hopkins’ Joshua Sharfstein says.
By Meg Bryant • July 31, 2017 -
CSR payments still in question after ACA repeal failures
With the deadline for adjusting individual market rates a little more than two weeks away, insurance companies are pleading with the White House and Congress to make the payments.
By Shannon Muchmore • July 31, 2017 -
Evergreen Health in tailspin after purchase group backs out
Just last month, Maryland’s insurance regulator gave the co-op the green light to move to for-profit status.
By Meg Bryant • July 28, 2017 -
Lawsuit alleges UnitedHealth concealed Medicare Advantage complaints
The payer is facing multiple other allegations of orchestrating overpayments in the Medicare Advantage program.
By Les Masterson • July 28, 2017 -
Uncompensated care funding cuts set to begin next year
The CMS issued a proposed rule on Thursday that would enact ACA-mandated reductions to state Medicaid disproportionate share hospital payments.
By Jeff Byers • July 28, 2017 -
ACA repeal dealt major blow with failed early morning vote
Efforts to repeal the ACA aren't officially dead, but the latest setback raises further questions as to how or whether Republicans plan to proceed.
By Shannon Muchmore • July 28, 2017 -
Deep Dive
Don't let the name fool you, ACA 'skinny' repeal has major consequences
A scaled-down version of ACA repeal is the latest GOP healthcare proposal, but it may just be a vehicle for returning to earlier, more conservative legislation.
By Shannon Muchmore • July 27, 2017 -
Healthcare deal volume may be down, but megadeals and value rose in Q2
PwC Deal Insights found there were 10 megadeals in health services in the second quarter valued at a total of $43.3 billion.
By Les Masterson • July 26, 2017
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