Payer: Page 173
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ACA markets still tenuous, former HHS head Sebelius says
Premiums may rise next year and insurers internally debate whether to exit or expand markets.
By Meg Bryant • May 13, 2016 -
Study: Quit smoking and healthcare costs will plummet
According to the study, $63 billion could be saved if every state reduced smoking rates by 10%.
By Meg Bryant • May 13, 2016 -
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 -
OIG takes HHS to task over $125B in Medicare improper payments
The report found HHS did not fully comply with several requirements for reducing improper payments last year.
By Meg Bryant • May 13, 2016 -
Humana adds at least 2 states to ACA market departures
At least 26,000 enrollees will need new coverage for 2017.
By Heather Caspi • May 12, 2016 -
California projects 8% increase in 2017 ACA premiums
The number may be on the low end compared to other states.
By Heather Caspi • May 12, 2016 -
Insurers seek value-based drug prices
With U.S. prescriptions climbing to almost $425 billion in 2015, insurers want to see performance.
By Heather Caspi • May 12, 2016 -
Less than 1% of rural Medicare beneficiaries benefit from telemedicine, study says
The majority of rural telemedicine visits for those with Medicare occurred in outpatient clinics for mental health services.
By Nina Flanagan • May 12, 2016 -
Pay for performance fails to improve patient outcomes, study finds
Lack of evidence of improved outcomes held true even when the researchers looked at subgroups of hospitals and poor performers.
By Meg Bryant • May 11, 2016 -
GAO: Medicare failing to curb overbilling by Advantage plans
The report found risk adjustment data validation has cost the government about $117 million for audits while recouping only $14 million.
By Heather Caspi • May 11, 2016 -
Zoom+ bucks system with targeted health plan
The company is going after millennials with a one-stop shop strategy.
By Heather Caspi • May 11, 2016 -
Montgomery County Planning Commission
Aetna not exiting ACA exchanges, could expand market presence
The insurer noted it won't finalize its ACA market plans until September.
By Jeff Byers • May 11, 2016 -
Clinton campaign revives push for public option
Clinton on the campaign trail this week discussed letting younger individuals buy into Medicare.
By Heather Caspi • May 11, 2016 -
Slavitt: MACRA won't hinder solo, small practices
Stakeholders have until June 27 to submit MACRA implementation feedback to CMS.
By Ana Mulero • May 11, 2016 -
More than 40 patient groups criticize CMS' proposed Part B model
The groups raised concerns about CMS' proposed use of comparative effectiveness research and cost effectiveness.
By Nina Flanagan • May 10, 2016 -
Deep Dive
U.S. inches closer to national single-payer plan conversation
With more than 2,200 physicians supporting a single-payer proposal last week, are we ready to seriously discuss the possibility of a single-payer program?
By Julie Henry • May 10, 2016 -
New CMS regs allow struggling ACA co-ops to appeal to private investors
In addition, the agency amended requirements for the organizations' directors.
By Heather Caspi • May 9, 2016 -
Cigna questions whether Anthem merger will close in 2016
The deal could be in jeopardy as Cigna noted Anthem could owe a breakup fee of $1.85 billion if the deal isn’t finalized by Jan. 31, 2017.
By Heather Caspi • May 9, 2016 -
ACA bronze plans could be at risk after proving least profitable
Experts disagree whether the insurers will phase out the plans and further destabilize the marketplace.
By Heather Caspi • May 9, 2016 -
CMS releases new Medicare data in bid to increase transparency
The 2014 dataset includes information for more than 986,000 physicians who received a total of $91 billion in Medicare payments.
By Meg Bryant • May 6, 2016 -
2,000 doctors endorse single-payer healthcare reform proposal
New taxes to fund a single-payer system would be offset by reduced premiums and out-of-pocket spending, under a proposal in the American Journal of Public Health.
By Meg Bryant • May 6, 2016 -
California fines Anthem $415K over grievance violations
Opponents of the ending Cigna merger have pointed toward Anthem's historic issues with the grievance process as a reason to halt the deal.
By Heather Caspi • May 5, 2016 -
Opioid epidemic costs shifting to insurers
CDC analysis found consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents dropped from $4.40 to $0.90.
By Heather Caspi • May 5, 2016 -
Deep Dive
Performance measures put heat on hospitals
Stakeholders react to the abundance of federal performance measures. Some say doctors just want more time to take care of their patients.
By Meg Bryant • May 5, 2016 -
Tenet posts $59M Q1 loss as lawsuit reserve grows to $407M
The company predicts competition will take on UnitedHealth's deserted ACA markets and stated it will be happy to fight for it.
By Meg Bryant • May 4, 2016 -
Low costs land 231 hospitals a Medicare bonus — despite low quality
CMS said it may revise regulations so hospitals rated below the national quality average won’t receive a bonus in the future.
By Meg Bryant • May 4, 2016
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