Payer: Page 148
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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 -
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 -
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 -
Providers waiting for guidance on new Medicare ID cards
Cards with new ID numbers called Medicare Beneficiary Identifiers will be issued in April 2018, and no cards with old numbers will be accepted as of 2020.
By Meg Bryant • June 23, 2017 -
Deep Dive
5 highlights from the Senate's ACA replacement bill
The 142-page bill has many of the same provisions as the House version passed last month, but it comes with some key differences as well.
By Shannon Muchmore • June 23, 2017 -
Cigna eyeing M&A activity, Medicare Advantage growth
The CMS recently lifted Cigna’s 17-month suspension on selling MA plans.
By Les Masterson • June 22, 2017 -
UPDATE: Senate version of AHCA cuts Medicaid differently
AHA President Rick Pollack said of the bill, "Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance."
By Shannon Muchmore • June 22, 2017 -
Anthem pulls back on ACA exchanges while Oscar expands footprint
Many payers said they remain committed to the ACA exchanges. They could still change their minds before 2018, though, as Wednesday's deadline was not the final one.
By Les Masterson • June 22, 2017 -
Qliance's demise brings questions about direct primary care model
At its peak, Qliance served 35,000 patients at clinics in the Seattle area, but that number dropped to 13,000 earlier this year.
By Les Masterson • June 21, 2017 -
Study shows patients aren't protected from surprise bills
Only six states provide a “comprehensive approach to protect consumers," but even those laws have loopholes.
By Les Masterson • June 21, 2017 -
On exchange deadline day, states are hoping for commitments
A new report from Avalere found that residents in more than 40% of counties may have only one payer option in their 2018 ACA exchange market.
By Les Masterson • June 21, 2017 -
CMS proposal exempts another 134K from MACRA
The agency is continuing to give small and rural providers a reprieve. In May, more than 800,000 clinicians were informed they will not be evaluated under the MIPS program.
By Jeff Byers • June 20, 2017 -
Deep Dive
Alzheimer's patients need special care, but providers aren't ready to give it
One in 10 Americans 65 and older has Alzheimer’s disease, which is expected to cost nearly $260 billion this year.
By Les Masterson • June 20, 2017 -
UnitedHealth, Aledade partner on Medicare Advantage accountable care program
More than 15,000 of UnitedHealth’s MA members are eligible for the Arkansas-based program.
By Les Masterson • June 19, 2017 -
ER visits up, uninsured visits down in Medicaid expansion states
The study’s lead author said the impact of Medicaid expansion varied greatly depending on the state.
By Les Masterson • June 19, 2017 -
MedPAC suggests MIPS overhaul, more site-neutral payments
The committee's June report calls for faster changes to the post-acute care settings prospective payment system, but the AHA doesn't support such a change.
By Shannon Muchmore • June 19, 2017 -
Evergreen Health to go for-profit in Maryland insurance market
Allowing Evergreen, originally a nonprofit insurer, to compete in Maryland’s individual health plan market serves the public interest, Insurance Commissioner Al Redmer said.
By Meg Bryant • June 16, 2017 -
Oscar, Cleveland Clinic team up to offer health plans in Ohio
The payer has also signed on to offer plans for small business employers on the HealthPass New York exchange.
By Meg Bryant • June 16, 2017 -
Cigna can sell Medicare Advantage plans again
Some believe the news could be the harbinger for a potential Cigna-Humana merger.
By Jeff Byers • June 16, 2017
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