$1B Medicare fraudster gets September 2017 trial date

Nursing home operator Philip Esformes allegedly drove patients to his facilities using a network of corrupt providers.

By Meg Bryant • Nov. 4, 2016

Cigna ACA expansion plans stall as profits fall

Losses stemming from a CMS ban levied in January on Medicare participation continue to cost Cigna. 

By Luke Gale • Nov. 4, 2016

Explore the Trendline➔

Payer/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

CDC: Uninsured rates falling, deductibles rising under ACA

The Affordable Care Act has helped more than 20 million get health insurance, but many more remain uninsured. 

By Luke Gale • Nov. 4, 2016

Anthem floats 2018 ACA exit amid profit slip, lawsuits

The health insurance giant may follow its rivals out of the marketplace if adjustments to healthcare policy aren't made.

By Heather Caspi • Nov. 3, 2016

An ACA primer: Much more than insurance

A major focus of the ACA is increasing access to primary care.

By Meg Bryant • Nov. 2, 2016

Why selling insurance across state lines is an unlikely solution

Proposals to allow the sale of health insurance across state lines make a lot of promises that would likely go unfulfilled. 

By Luke Gale • Nov. 2, 2016

CMS issues final rule on hospital payment rates for 2017

The agency followed through on a proposal to remove patient survey answers as part of pain management care in the Value-Based Purchasing program.

By Luke Gale • Nov. 2, 2016

Trump raises questions with promise for special session to repeal ACA

Concern has been stirred once again by Trump's language.

By Heather Caspi • Nov. 2, 2016

Blue Shield of California repays millions in rebates, again

The company stands out among insurers for the amount of money its owed. 

By Heather Caspi • Nov. 2, 2016

Updated payment process aims to reshape RAC program

Along with new contracts come updates to how RACs are paid, audit timelines and the review process. 

By Heather Caspi • Nov. 2, 2016

NorthShore/Advocate merger has been put on ice by a federal appeals court

A recent JAMA Forum discussion opined the future of ACA could potentially be at the mercy of provider consolidation.

By Heather Caspi • Nov. 1, 2016

Physician participation dips in marketplace plans, SERMO says

With lessened insurer participation comes lessened provider participation.

By Heather Caspi • Nov. 1, 2016

HHS restricts short-term insurance plans to under 3 months

Americans that purchase short-term plans will have to pay the individual penalty as they won't have ACA-compliant coverage and health insurers must notify their customers under the new rule.

By Ana Mulero • Oct. 31, 2016

Survey: 29% of physicians still haven't heard of MACRA

With the final rule now out, physicians should be making their plans for 2017.

By Heather Caspi • Oct. 31, 2016

Patient ratings added to Dialysis Facility Compare website

CMS is furthering its push for transparency and improved accuracy in star ratings.

By Heather Caspi • Oct. 31, 2016

Patient factors dominate readmissions risks, study finds

The findings contribute to the discussion whether current Medicare policy is unfairly penalizing hospitals with significant poor and minority populations when it comes to readmission rates.

By Heather Caspi • Oct. 30, 2016

Technology, outreach efforts prime ACA open enrollment season

Mobile apps, Lyft partnerships and "hyperlocal" outreach have been included in efforts to boost insurance enrollment.

By Jeff Byers • Oct. 29, 2016

AHA sees erosion of physician judgment in DOJ false claims suit

DOJ accused Prime Healthcare of encouraging doctors to admit Medicare patients for short hospital stays instead of outpatient observation care.

By Meg Bryant • Oct. 28, 2016

Aetna profits from government programs, just not ACA

Sales of plans through Medicare and Medicaid contracts helped fuel a strong third quarter for the insurance giant.

By Meg Bryant • Oct. 28, 2016

ACA marketplace stability, or lack thereof, to come into focus in 2017

Kaiser Family Foundation's CEO Drew Altman's argues next year's insurer quarterly earnings reports will show whether their rates are aligning with their costs.

By Heather Caspi • Oct. 27, 2016

Study: Insurance cost squeeze on workers real, though premiums not to blame

While cost growth has slowed since the ACA, incomes have not kept up.

By Heather Caspi • Oct. 27, 2016

Covered California highlights recipe for individual marketplace success

The state shares how it has made the health law work for the most part.

By Heather Caspi • Oct. 26, 2016

Ignorance around 'Obamacare' impairs discussion

Trump made some remarks on the ACA on Tuesday which didn't add up.

By Heather Caspi • Oct. 26, 2016

How payers are tackling value-based drug pricing

Efforts to establish such pricing are on the rise as payers and providers challenge drug makers to help improve health outcomes. However, barriers to these payment models remain. 

By Luke Gale • Oct. 26, 2016

Advanced APMs: What they are and why they matter

Providers should look at both the downside risk potential and cost of implementing an Advanced APM.

By Meg Bryant • Oct. 26, 2016