Payer: Page 145
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Study: Low-cost health plans exclude top quality cancer docs
Narrow network health plans cost less for payers to provide and have lower premiums, but along with high out-of-pocket costs, the level of care available may need more study.
By Meg Bryant • July 7, 2017 -
65% of healthcare partnerships lead to cost savings, study shows
More than half of respondents in a survey from the Partnership for Healthy Outcomes said their partnerships include care coordination support.
By Les Masterson • July 7, 2017 -
GAO: CMS erred in giving bonuses to lower-quality hospitals
The Hospital Value-Based Purchasing Program rewarded some hospitals because of favorable efficiency scores, despite their lower quality metrics, according to the report.
By Meg Bryant • July 7, 2017 -
Report: UnitedHealth could purchase Advisory Board Company's health division
Bloomberg reported UnitedHealth and Vista Equity Partners are looking to purchase and split apart the Washington, DC-based consultant's healthcare and education services.
By Jeff Byers • July 6, 2017 -
Deep Dive
Seeking greater flexibility, MACRA's MIPS could be more confusing for clinicians in 2018
“The point is to find a smart way to minimize the burden without undercutting the point of the whole effort,” says Numerof & Associates managing partner Michael Abrams of CMS’ 2018 Quality Payment Program proposed rule.
By Meg Bryant • July 6, 2017 -
Minnesota payer contract dispute ends with children's health system dropped from network
The largest child care delivery system in the Minneapolis area is now considered out-of-network for 66,000 Blue Cross and Blue Shield of Minnesota policyholders.
By Les Masterson • July 6, 2017 -
MedStar stumps to keep D.C. Medicaid contract
The D.C. Department of Health Care Finance didn't choose MedStar as one of three companies for its new five-year managed care Medicaid contracts.
By Les Masterson • July 5, 2017 -
CMS pulls Medicare Advantage data release
The agency said there were problems with the data's accuracy.
By Les Masterson • July 3, 2017 -
Centene will fill Missouri ACA exchange gaps
The payer will offer plans in 25 "bare counties" that would have no ACA exchanges options in 2018 after Blue Cross Blue Shield of Kansas City announced it is dropping out of those areas.
By Les Masterson • July 3, 2017 -
Hospital outpatient payments lower in states with fixed fees, study finds
Workers' compensation payouts in Alabama for common outpatient surgeries were as much as 527% higher than Medicare rates.
By Meg Bryant • June 30, 2017 -
CBO: Senate healthcare bill will reduce Medicaid spending 35% by 2036
Senate Majority Leader Mitch McConnell delayed a vote on the Better Care Reconciliation Act of 2017 before the July 4th recess after failing to garner enough Republican support for the bill.
By Les Masterson • June 30, 2017 -
Survey: Few clinicians prepared for Quality Payment Program
The American Medical Association found just 8% of physicians said they were “deeply knowledgeable” about QPP.
By Meg Bryant • June 29, 2017 -
Aetna moving HQ to New York
The payer is moving 250 jobs from its Hartford, Connecticut headquarters, where it has been located since its founding more than 150 years ago.
By Les Masterson • June 29, 2017 -
Cardiac monitoring firms, exec to pay $13M over Medicare false claims allegations
The settlement underscores the government’s commitment to cracking down on fraud and abuse.
By Meg Bryant • June 28, 2017 -
No vote on Senate healthcare bill before July 4 holiday
After the CBO analysis of the bill was released Monday, it became clear that not enough Republican senators were satisfied with the bill and there wouldn't be enough time to change their minds.
By Shannon Muchmore • June 28, 2017 -
Contract dispute between MN insurer, children's health system goes public
The current contract between Blue Cross and Blue Shield of Minnesota and Children's Hospitals and Clinics of Minnesota ends on July 5.
By Les Masterson • June 27, 2017 -
CBO reports show private insurers pay physicians, hospitals far more than Medicare
The agency found the average commercial payment rate for a hospital admission was $21,400 in 2013, compared to $11,400 for a Medicare FFS patient.
By Les Masterson • June 27, 2017 -
Kaiser Permanente again cited for mental health access problems
In 2013, the California integrated healthcare system agreed to pay $4 million for “several deficiencies in the plan’s delivery of mental health services.”
By Les Masterson • June 27, 2017 -
Insurance improves health outcomes, report shows
The authors found health insurance leads to greater access to preventive services, chronic illness treatment, medications and surgery.
By Les Masterson • June 27, 2017 -
CBO: Senate bill would mean 15M lose coverage next year
CBO concluded that if the bill passes, “few low income people would purchase any plan,” because of an actuarial benchmark change.
By Shannon Muchmore • June 26, 2017 -
Deep Dive
9 major takeaways from the 2018 MACRA proposed rule
In addition to allowing for more physician exemptions from the program next year, CMS is proposing to let physicians continue to use 2014 certified EHR technology for MIPS scoring.
By Jeff Byers • June 26, 2017 -
Report: $262B in healthcare claims initially denied last year
As much as 3.3% of net patient revenue is put at risk because of denials for a typical health system, an analysis from Change Healthcare found.
By Les Masterson • June 26, 2017 -
Anthem to pay record $115M to settle data breach lawsuit
The payer agreed to set aside funding for cybersecurity improvements, as well as cover two years of credit protection and $15 million worth of out-of-pocket costs for those affected.
By Shannon Muchmore • Updated Aug. 16, 2018 -
Medtronic partners with Aetna on value-based diabetes program
The outcomes-based, risk-sharing agreement will tie Medtronic’s reimbursement to meeting agreed-upon clinical improvement thresholds for Aetna members with type 1 and type 2 diabetes.
By Les Masterson • June 24, 2017 -
Georgia hospital close to closure sues BCBS over reduced payments
Cornerstone Medical Group is the only hospital in rural Walker County.
By Meg Bryant • June 23, 2017
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