Payer: Page 157
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OIG: New Jersey falsely claimed $94M worth of Medicaid reimbursements
OIG recommended the state agency refunds the money to the federal government. The state disagreed.
By Jeff Byers • Dec. 30, 2016 -
Deep Dive
The optimism and challenges for putting the 'value' in value-based care
Providers describe a “sweet spot” between getting optimal quality and achieving that at a reasonable cost.
By Meg Bryant • Dec. 30, 2016 -
Aetna, Humana extend planned merger end date
A federal judge is expected to rule on the government’s antitrust lawsuit to block the megamerger sometime in January.
By Meg Bryant • Dec. 23, 2016 -
S&P says 2017 a 'one-time pricing correction' for ACA markets
The report predicts next year will see the insurers that sell ACA plans "getting close to break even or better."
By Jeff Byers & Meg Bryant • Dec. 23, 2016 -
Deep Dive
2016 may be the end of the ACA blame game
Consumers have been facing greater price increases, as well as monopolies in the health insurance and medical fields.
By Ana Mulero • Dec. 22, 2016 -
Deep Dive
How payers are responding to the opioid crisis
With the cost of claims associated with opioid abuse and dependence skyrocketing, payers are using analytics and working with providers and patients to address the problem.
By Luke Gale • Dec. 21, 2016 -
CBO: Minimal insurance products not counted as coverage
The definition of "health coverage" will be a hot topic as the GOP preps an ACA replacement plan.
By Jeff Byers • Dec. 20, 2016 -
Deep Dive
New CMS APMs finalize cardiac, orthopedic bundled payment models
The agency also finalized the Medicare ACO Track 1+ Model to encourage smaller practices to participate in performance-based risk.
By Ana Mulero • Dec. 20, 2016 -
Federal task force reveals evidence gaps in preventive health services
Areas where more research is needed include autism screening and aspirin therapy to prevent cardiovascular disease and colorectal cancer.
By Meg Bryant • Dec. 20, 2016 -
Last week held a banner day for ACA signups
The uptick in enrollment suggests greater ACA risk pool stabilization.
By Jeff Byers • Dec. 19, 2016 -
Alex Wong via Getty Images
CMS aims at stabilizing risk pool with 2018 ACA exchange rule
The new risk adjustment model will incorporate prescription drug data, among other modifications.
By Ana Mulero • Dec. 19, 2016 -
Government can't pay insurers billions owed for risk corridors
The risk corridor program was supposed to help payers recoup costs spent on the sickest patients in the individual insurance markets. It hasn't worked out as planned and payers are receiving a fraction of the money they are owed.
By Luke Gale • Dec. 19, 2016 -
CMS adds two more Advanced APMs in press to grow participation
CMS expects 25% of clinicians will participate in Advanced Alternative Payment Models by 2018.
By Meg Bryant and Ana Mulero • Dec. 16, 2016 -
20% of ER inpatient cases result in surprise medical bills
States with the highest rates of surprise medical bills include New York, New Jersey and Texas, according to a new study published in Health Affairs.
By Meg Bryant • Dec. 16, 2016 -
Top 1% would see big tax cut with ACA repeal
Republican plans to dismantle Obamacare would end health insurance for millions of Americans — and do away with several taxes on high-income households.
By Meg Bryant • Dec. 16, 2016 -
OIG: Florida Medicaid program paid $26M to private payers for dead beneficiaries
The overpayments have raised some concern over the costs associated with a privately administered Medicaid model.
By Luke Gale • Dec. 15, 2016 -
Medisafe, major EHRs spotlight interoperable medication lists
A new report by Surescripts shows 93% of surveyed patients favor storing all their medications in one location.
By Meg Bryant • Dec. 15, 2016 -
Carequality, CommonWell partner on interoperability, data sharing
The collaboration’s aim is to make it easier for providers to get health information that could be useful in making decisions about diagnosis and treatment for their patients.
By Meg Bryant • Dec. 15, 2016 -
Alex Wong via Getty Images
HHS takes stock of uninsured rates, quality of care under ACA
With the future of the ACA in question, HHS released new data stumping for the legislation’s effectiveness.
By Kathleen McGuire Gilbert • Dec. 14, 2016 -
CVS Health launching an analytics-based initiative to deliver personalized diabetes care
The company hopes its new program will allow each participating client to save as much as $5,000 annually.
By Luke Gale • Dec. 14, 2016 -
Humana CEO offers 5-point plan for curbing ER use
Primary care providers should act as the “quarterback” in the healthcare system, directing patients to specialists as needed and helping to reduce unnecessary ER visits, CEO Bruce Broussard says.
By Meg Bryant • Dec. 13, 2016 -
HHS: Preventing hospital-acquired infections saved $28B
More than 3 million of such infections were prevented from 2010 through 2015, according to the agency.
By Ana Mulero & Jeff Byers • Dec. 12, 2016 -
Oscar, Mount Sinai cut ribbon on new Brooklyn clinic
Convenience is a hot topic in healthcare these days and the insurer could be looking long-term toward a chain of clinics across the U.S.
By Meg Bryant • Dec. 9, 2016 -
Evergreen dropped from Maryland's 2017 individual insurance market
The health insurance co-op has been trying to segue into a for-profit status after facing financial ruin earlier this year.
By Meg Bryant • Dec. 9, 2016 -
CMS aims to empower patients with new engagement models
Organizations can begin applying now.
By Ana Mulero • Dec. 9, 2016
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