Payer: Page 141
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OIG: Medicare overpaid $729M in EHR incentives
The report chided the CMS on its scant documentation reviews, which put the program at risk of abuse and misused funds.
By Meg Bryant • June 13, 2017 -
Centene goes rogue in expanding ACA exchange plans
Among news of other payers pulling out of the exchanges, the company says it is “well positioned” to expand services.
By Les Masterson • June 13, 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 -
Deep Dive
DOJ sends warning shots on Medicare Advantage overpayments
Recent claims against UnitedHealth Group highlight the federal government's effort to recoup what it says is billions in overpayments.
By Les Masterson • June 13, 2017 -
FBI investigating Zoom+ for ACA risk adjustment fraud
The startup allegedly made members look less healthy, which meant it didn't pay as much for risk adjustment.
By Les Masterson • June 12, 2017 -
Iowa has a plan to get payers back in ACA exchanges
The plan, which asks for $80 million from the federal government, includes a reinsurance program to help cover high-cost beneficiaries and makes changes to premium support payments.
By Shannon Muchmore • June 12, 2017 -
Court rejects Methodist Health Service's $300M antitrust case against competitor
The lawsuit was filed against St. Francis in 2013, claiming the “larger and more profitable” hospital violated the Sherman Act to the detriment of Methodist.
By Ana Mulero , Les Masterson • June 12, 2017 -
Deep Dive
AHIP17: New vision for healthcare calls for bold, forceful changes
Providing better care at a lower cost is “truly an achievable goal,” Anthem President and CEO Joseph Swedish said.
By Ana Mulero • June 12, 2017 -
HHS wants help identifying 'burdensome' ACA regs
The department says it wants to identify regulations that interfere with job growth, impose costs exceeding benefits, create serious inconsistency or are simply outdated, unnecessary or ineffective.
By Shannon Muchmore • June 12, 2017 -
AHIP17: Payers, providers disagree on value-based care preparedness
More than half of surveyed health plans said providers have the tools they need to support value-based care, but 43% of physicians said they are still lacking these tools, according to a new Quest Diagnostics study.
By Ana Mulero • June 12, 2017 -
Most new provider-sponsored health plans not profitable
A Robert Wood Johnson Foundation report found many such systems are not aligning clinically integrated networks and accountable care organizations to their health plan strategy. Instead, they are reducing costs by paying providers less.
By Les Masterson • June 12, 2017 -
Price remains mum on CSRs, AHCA details at budget hearings
With less than two weeks until the deadline for participating in the ACA exchanges, it’s getting too late for promises on cost-sharing payments to matter.
By Shannon Muchmore • June 9, 2017 -
TMF: Patient portals can reduce phone calls
LexisNexis Risk Solutions and the AMA have also jointly launched an online portal designed to keep health plan provider directories up to date.
By Meg Bryant • June 8, 2017 -
Medicare Advantage premiums steady as membership grows
One-third of Medicare beneficiaries are covered by a Medicare Advantage plan.
By Les Masterson • June 8, 2017 -
Deep Dive
Is value-based care making a difference?
“CMS is pleased with the trend … but the actual dollar amounts that are being saved are not huge compared to the healthcare spend overall,” says healthcare consultant Holly Martin.
By Meg Bryant • June 7, 2017 -
Anthem pulls out of Ohio, leaving more with no ACA plan choices
The insurer said one of the main reasons for its exit is “increasing lack of overall predictability,” such as whether cost-sharing payments will continue.
By Shannon Muchmore • June 7, 2017 -
Nevada legislature passes Medicaid for all
Gov. Brian Sandoval has yet to say whether he will sign the bill, and there are plenty of other outstanding questions such as the plan design and cost.
By Les Masterson • June 6, 2017 -
Tenet, Humana come to agreement on new contract
The companies had failed to reach an agreement in 2016, which left Humana members unable to get covered care in Tenet facilities.
By Les Masterson • June 6, 2017 -
Single-payer healthcare system in California still a long way from reality
The state Assembly needs to finalize the bill to add more specifics about the proposed system and how the state would fund it.
By Les Masterson • June 5, 2017 -
Opinion
Performance improvement initiatives: Are you playing 'whack-a-mole'?
Without looking at enterprise-wide performance indicators and their often complex interplay, organizations risk playing “whack-a-mole” with their performance improvement efforts, argues David Costello, chief analytics officer at Verscend Technologies.
By David Costello • June 5, 2017 -
States are watching as payers decide ACA exchange participation
As more insurers announce they are pulling out of the exchange markets and others say they need to file substantial premium increases, states are warning of few choices and high costs for their residents.
By Shannon Muchmore • June 5, 2017 -
Provider groups ask Medicare Advantage be counted as APM under MACRA in 2019
The groups requested that the agency include MA for the 5% Quality Payment Program bonus in 2019 and 2020.
By Les Masterson • June 5, 2017 -
For-profit hospitals lead the pack of widely varied ED charges
The markups often result in surprise medical bills, which state legislatures are trying to fight.
By Meg Bryant • June 2, 2017 -
EHR vendor eClinicalWorks to pay $155M in False Claims Act case
This is the first time an EHR vendor has been held accountable by the government "for failing to meet federal standards designed to ensure patient safety and quality patient care,” a partner at Phillips & Cohen said.
By Meg Bryant • June 1, 2017 -
Freedom Health agrees to pay $31.7M to settle Medicare Advantage whistleblower case
The DOJ said the organization submitted or caused others to submit unsupported diagnosis codes to the CMS and made “material misrepresentations to CMS regarding the scope and content of its network of providers."
By Les Masterson • May 31, 2017 -
AstraZeneca taps outcomes deals to boost cardio, diabetes meds
Two agreements with Harvard Pilgrim for Brilinta and Bydureon will link drug costs to certain patient outcomes — the most recent examples of value-based deals.
By Ned Pagliarulo • May 31, 2017
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