Payer: Page 165
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GAO details fraud, satisfaction in marketplace performance reports
Room for improvement remains in the areas of fraud prevention and consumer satisfaction.
By Heather Caspi • Sept. 14, 2016 -
CMS: Nearly all states reduced preventable hospital readmissions
Vermont was the only state where the rate increased in 2015.
By Ana Mulero • Sept. 14, 2016 -
Study: Patients with consumer-driven health plans pay more, consume less
Total spending on patients with consumer-driven health plans is lower than average, but patients pay much more out-of-pocket.
By Luke Gale • Sept. 14, 2016 -
Aetna's Bertolini counters accusation of power play against DOJ
The company did not present antitrust officials with an ultimatum, just "reality," its CEO says.
By Heather Caspi • Sept. 14, 2016 -
HHS risk corridors update invites insurer litigation
Legal action may be insurers' best bet for recovering unpaid funds owed to them under the program.
By Heather Caspi • Sept. 13, 2016 -
Risk adjustment debt of $46M forces another co-op to drop
Health Republic Insurance of New Jersey's exit will reduce options for ACA coverage from five this year to only two in the state.
By Ana Mulero • Sept. 13, 2016 -
Help: Obama looks to insurers for upcoming ACA marketplace enrollment period
The president met on Monday with the heads of select insurance companies to discuss ACA marketplace participation, stabilization.
By Jeff Byers • Sept. 13, 2016 -
Oscar names new chief medical officer in midst of strategy adjustment
Shaden Marzouk enters as the company looks toward its own health center and a slashed provider network.
By Heather Caspi • Sept. 13, 2016 -
Waterborne infection hospitalizations for Medicare beneficiaries may reach $2 billion
Hospitals that provided treatment for three studied infections received a total of $9 billion from 1991 through 2006.
By Ana Mulero • Sept. 12, 2016 -
New York regulators urged to reject Anthem/Cigna deal
Opponents argue the proposed megamerger would be "bad medicine" for New Yorkers.
By Heather Caspi • Sept. 12, 2016 -
Aetna faces probe over 'politically motivated' Obamacare exit
The company is accused of trying to force DOJ antitrust regulators to accept its merger with Humana.
By Heather Caspi • Sept. 12, 2016 -
New ACA attacks aim to put cracks in individual mandate
Two new proposals could allow widespread exemptions for consumers facing certain marketplace conditions.
By Heather Caspi • Sept. 9, 2016 -
Study supports surgery at high quality hospitals for lower overall spending
Investing up front can save money down stream, researchers have shown.
By Heather Caspi • Sept. 9, 2016 -
Cigna can't resolve sanctions in time for 2017 Medicare Advantage enrollment
Investors didn't indicate any alarm over the news.
By Heather Caspi • Sept. 8, 2016 -
While uninsured rate hits historic low, young adults still not sold
CMS will need to attract more of this demographic to help balance the risk pools for ACA health plans.
By Heather Caspi • Sept. 8, 2016 -
CMS fills in regulatory gaps in emergency preparedness with final rule
Medicare and Medicaid providers will be required to meet four new standards based on emergency planning, policies and procedures, a communication plan, as well as training and testing programs.
By Ana Mulero • Sept. 8, 2016 -
Mylan accused of overcharging Medicaid for EpiPen
If the product is found to have been misclassified as a generic, will a full review follow?
By Heather Caspi • Sept. 8, 2016 -
CMS puts weight behind 2017 ACA enrollment
Grants totaling $63 million will help fund "navigators" to walk consumers through their marketplace experience.
By Heather Caspi • Sept. 7, 2016 -
Deep Dive
What's what in the 2018 Notice of Benefit and Payment Parameters
There are no proposals that are likely to be ineffective, according to Timothy Jost, a professor at the Washington and Lee University School of Law.
By Luke Gale • Sept. 7, 2016 -
ACA's 'free' birth control still elusive to many
Choice limitations and administrative barriers still delay or block some women seeking prescriptions.
By Heather Caspi • Sept. 7, 2016 -
Study: Medicaid expansion not impacting length of stay or mortality
While Medicaid expansion may be impacting the healthcare landscape, it does not appear to be impacting these two measures.
By Heather Caspi • Sept. 6, 2016 -
'Simple choice plans' may not be so simple
The rollout of “simple choice plans” will depend on a few factors, including which regions will still have sufficient insurer participation to support choices in the first place.
By Heather Caspi • Sept. 6, 2016 -
Anthem to reward providers for integrated care certification
The Joint Commission began the integrated care certification program in July 2015.
By Meg Bryant • Sept. 2, 2016 -
St. Luke's, Geisinger team up to hold down costs
The agreement includes plans for a new Medicare Advantage plan.
By Meg Bryant • Sept. 2, 2016 -
Taxpayers cover 71% of health costs in California
Medi-Cal comprised the largest chunk of public spending at 27%.
By Meg Bryant • Sept. 2, 2016
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