Payer: Page 168
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Deep Dive
Timeline: Anthem's pending $54B acquisition of Cigna
This is their story.
By Ana Mulero • Aug. 17, 2016 -
Alabama looks at lottery funding for Medicaid
Even if it passes, however, the question is how long it can solve the problem.
By Heather Caspi • Aug. 17, 2016 -
Montgomery County Planning Commission
Battle of the bulls: Aetna threatened ACA participation over Humana merger blockage
The Huffington Post reveals deeper motivations for Aetna's recent ACA exit.
By Jeff Byers • Aug. 17, 2016 -
Fake owner pleads guilty in $4.2M home health fraud scheme
The Medicare Fraud Strike Force has taken down another Florida scheme.
By Heather Caspi • Aug. 17, 2016 -
Aledade launches new Arkansas ACO
The company says it is the first primary care physician-led ACO in the state.
By Heather Caspi • Aug. 17, 2016 -
Sutter Health to employers: Waive rights to sue or pay the price
Some California employers face a difficult decision.
By Luke Gale • Aug. 17, 2016 -
First decision made in Iowa/HHS tussle over failed co-op funds
The health of the risk adjustment program appeared to take priority.
By Heather Caspi • Aug. 16, 2016 -
Deep Dive
Timeline: Aetna's pending $37B acquisition of Humana
Aetna and Humana say they are prepared to “vigorously defend their pending transaction” against an antitrust lawsuit in a court trial set to begin on December 5.
By Ana Mulero • Aug. 16, 2016 -
Montgomery County Planning Commission
Aetna to leave 536 individual markets in major ACA exchange withdrawal
The insurer is doubling down on reversing expansion plans in the individual market.
By Jeff Byers • Aug. 15, 2016 -
New York announces ACA plan enrollment total of 2.8 million
The state credits its new Essential Plan for much of its 2016 enrollment growth.
By Heather Caspi • Aug. 15, 2016 -
Anthem/Cigna merger under the gun with antitrust ruling expected in January 2017
It will be down to the wire and a hair behind the Aetna/Humana merger trial.
By Heather Caspi • Aug. 15, 2016 -
Shut it down: Blue Shield of California plans 4-day closure to help save $4M
The insurer is hoping to offset its ACA exchange losses.
By Heather Caspi • Aug. 15, 2016 -
From the frying pan to the fire: New Mexico insurance exchange CEO to call Molina new home
Amy Dowd is moving on after two years at beWellnm.
By Heather Caspi • Aug. 15, 2016 -
Math gaffe could cost Massachusetts hospitals $110M in Medicare funds
Rhode Island hospitals stand to lose $7 million, thanks to Massachusetts’ mistake.
By Meg Bryant • Aug. 12, 2016 -
New HHS data suggest risk pools are stabilizing but insurers stay skeptical
A CMS official suggests a new rule could be coming to help strengthen the ACA markets.
By Meg Bryant & Jeff Byers • Aug. 12, 2016 -
Court adopts Aetna/Humana-DOJ antitrust case schedule
The trial will last 13 days begining on December 5 and ending on December 21 - only 10 days before the insurers' contractual deadline.
By Ana Mulero • Aug. 12, 2016 -
Qui tam lawsuit to proceed against 5 Medicare Advantage participants
The lawsuit accuses UnitedHealthcare, Aetna and three other companies of submitting false certifications for Medicare Advantage payments.
By Meg Bryant • Aug. 12, 2016 -
Performance pressures cause hospitals to deny risky transplants
In the first five years since the government set organ transplant standards, more than 4,300 candidates were dropped from waiting lists.
By Meg Bryant • Aug. 12, 2016 -
ACO's integration of behavioral health yields 13% decrease in ED visits, study finds
The program at UCLA Health is showing strong results nearly three years in.
By Heather Caspi • Aug. 11, 2016 -
CMS refines upcoming value-based Medicare Advantage model
Changes are in store for the second year of the program in 2018.
By Heather Caspi • Aug. 11, 2016 -
Telehealth shines in new employer healthcare benefits analysis for 2017
The National Business Group on Health estimates overall employee health benefit costs will rise 6% next year. Many insurers have been proposing double-digit premium rate increases for the ACA exchanges in 2017.
By Meg Bryant • Aug. 10, 2016 -
Bending of Medicare cost curve projected to save $2 trillion
The massive spending reduction indicates the long term viability of Medicare, the study suggests.
By Heather Caspi • Aug. 10, 2016 -
Deep Dive
Increase in parity supports building out mental health informatics
The lack of robust, standardized data fields for behavioral health could be an opportunity for health IT vendors.
By Jeff Byers • Aug. 10, 2016 -
Montgomery County Planning Commission
Aetna/Humana-DOJ antitrust trial date set for December
The date is later than the insurers were requesting.
By Jeff Byers • Aug. 10, 2016 -
Study findings fuel debate over whether Medicare Advantage offers better care at a lower cost
Medicare Advantage plans pay hospitals an average of 5.6% less for services than fee-for-service Medicare, according to a recent analysis.
By Heather Caspi • Aug. 10, 2016
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