Payer: Page 174
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Deep Dive
Supreme Court upholds implied certification theory under the FCA
Top priorities for all healthcare organizations should be to make sure appropriate resources are dedicated to compliance efforts and proactive compliance efforts are ongoing.
By Julie Henry • June 22, 2016 -
CMS sets sights on enrollment of young adults in 2017 marketplace
The effort aims to better balance the marketplace risk pool.
By Heather Caspi • June 22, 2016 -
More than 300 charged nationwide in massive $900M Medicare fraud sweep
It is "the largest in history, both in terms of the number of defendants charged and loss amount," DOJ reported.
By Jeff Byers • June 22, 2016 -
After 6 years, an outline of a plan to repeal the ACA hits the streets
The paper states the ACA "has proven unaffordable, unworkable, and intrusive in Americans’ everyday lives."
By Jeff Byers • June 22, 2016 -
HHS to fund small practices to help meet quality measures
Funded organizations will help small practices navigate issues such as which quality measures or EHR best meet their specific needs.
By Meg Bryant • June 22, 2016 -
Boeing seals direct contracting deal with major southern CA health system
Employers hope to reduce costs by bypassing insurance companies and contracting directly with health systems for employee benefits.
By Meg Bryant • June 22, 2016 -
KFF: Medicare Advantage networks come in all shapes, sizes & scope
Medicare Advantage enrollees in nine U.S. counties had no broad network options, a new report found.
By Meg Bryant • June 22, 2016 -
Healthcare shopping trends across U.S. all over the map
Women and adults ages 25 to 44 are most likely to shop for medical services, according to a new report by HealthSparq.
By Meg Bryant • June 22, 2016 -
Few consumers budgeting for healthcare, study finds
Most people don't know how much to expect to spend on their healthcare in a given year, a new report says.
By Heather Caspi • June 22, 2016 -
Elizabeth Regan/Healthcare Dive
RWJF estimates expect healthcare spending to reduce by $2.6T
The question is what factors are driving the difference.
By Heather Caspi • June 21, 2016 -
Public option poised to unite Democrats
Is it the ideal compromise, or just a mirage?
By Heather Caspi • June 21, 2016 -
Diabetes-related spending has gone up
A Health Care Cost Institute report shows people with diabetes had twice as many doctor and ER visits as people without the disease between 2012 and 2014.
By Ana Mulero • June 21, 2016 -
Deep Dive
4 forces that will influence medical cost trends in 2017
Consumers are increasingly likely to seek treatment at retail clinics, which will lead to increasing utilization and inflate costs in the future.
By Jeff Byers • June 21, 2016 -
CMS continues to shake up payer landscape, seeks adjustments to payment error rate measurements
A proposed rule could tighten up the programs that measure Medicaid improper payments and eligibility.
By Heather Caspi • June 21, 2016 -
Healthcare insecurity hits an all-time low
The number of American adults unable to afford healthcare dropped from 2013 to the first quarter of 2016, according to a new Gallup study.
By Jeff Byers • June 20, 2016 -
Montgomery County Planning Commission
CA reg grants Aetna/Humana merger approval, pins conditions to deal
Analysts expect the Humana/Aetna deal to have more of a fighting chance for regulatory approval than the Cigna/Anthem merger.
By Jeff Byers • June 20, 2016 -
Oscar attempts to hem ACA losses by expanding into provider territory
The health insurance darling is looking for a medical director and primary care physician for a member-exclusive health center.
By Heather Caspi • June 20, 2016 -
Patient's healthcare spending patterns established long before last months
A new study in Health Affairs shares insights into end-of-life care costs.
By Heather Caspi • June 20, 2016 -
Long-awaited CMS final rule updates clinical lab tests payments
Private rates will form the basis for most updates, the agency announced. Some say the impact could be substantial.
By Heather Caspi • June 20, 2016 -
Montgomery County Planning Commission
Aetna sues Nebraska over Medicaid contract loss
Aetna wants a continued share of Nebraska’s nearly $1 billion Medicaid market.
By Meg Bryant • June 17, 2016 -
Florida Blues reports $471M profit on 2015 ACA plans
The insurer is requesting a premium hike of nearly 10% despite its marketplace success.
By Heather Caspi • June 16, 2016 -
Popular ACA plans' premiums projected to increase by 10%
While it's still early in the rate process, complete proposals are available in 14 cities.
By Heather Caspi • June 16, 2016 -
CA insurance commissioner pleads to DOJ to block Anthem/Cigna
Dave Jones contends that the merger would highly reduce competition in the state, where three insurers constitute 75% of the insurance market.
By Jeff Byers • June 16, 2016 -
Slavitt shares 3 tips to improve value-based payments
CMS wants to give practices more flexibility to adapt the Quality Payment Program to their unique needs and make adjustments over time.
By Meg Bryant • June 15, 2016 -
CMS puts up $32M to target kids' enrollment in federal health programs
The Obama adminstration is continuing its efforts to get as many eligible children covered as possible.
By Heather Caspi • June 15, 2016
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