Payer: Page 147
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CMS proposes big 340B drug payment cuts, outpatient rate changes
The agency is also requesting ideas on regulatory and policy changes to advance flexibility, administrative simplification and innovation.
By Jeff Byers , Shannon Muchmore • July 13, 2017 -
Senate Republicans' new draft of healthcare bill makes few changes
The revised draft includes an amendment that would allow insurers to sell plans that do not meet minimum ACA requirements so long as they offer at least one plan that does. The insurance industry has opposed this idea.
By Shannon Muchmore • July 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 -
Medicare Advantage plans pay physicians about the same as traditional Medicare, study finds
Researchers reviewed 144 million claims for common services from 2007 to 2012.
By Les Masterson • July 12, 2017 -
Anthem Blue Cross expands program that denies claims for unnecessary ED services
The American College of Emergency Physicians and its Missouri chapter said rejecting ED claims is a “clear violation of the national prudent layperson standard.”
By Les Masterson • July 12, 2017 -
ACA is taking a toll on physician-owned hospitals
Physician Hospitals of America says the law stopped the building of 37 hospitals and halted 20 major expansion projects.
By Meg Bryant • July 11, 2017 -
Report: Cutting essential health benefits won't save much money
Republicans on Capitol Hill have raised the idea of cutting EHB requirements as they seek to replace the Affordable Care Act.
By Les Masterson • July 11, 2017 -
Medicaid beneficiaries report high satisfaction, access to care
The survey comes as the program faces a potential restructuring, including massive funding cuts and an end to expansion.
By Shannon Muchmore • July 11, 2017 -
Individual insurance market shows signs of stabilizing, report finds
A new Kaiser Family Foundation report found improved medical loss ratios and payer margins in the first quarter of 2017, but also rising premiums. CMS on Monday announced fewer payers have signed up for ACA exchanges for 2018.
By Les Masterson • July 10, 2017 -
Senate looking at Plan B if BCRA fails
Republican leadership is having a hard time deciding how it should proceed if the votes aren't there to pass their ACA replacement bill, which is increasingly the case.
By Shannon Muchmore • July 10, 2017 -
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
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