Aetna taps Hertz lawyer as new general counsel and EVP

The insurer's newest top execs know a thing or two about building brand loyalty.

By Heather Caspi • April 5, 2016

FL officials OK Anthem/Cigna acquisition, downplay state antitrust concerns

Florida's Office of Insurance Regulation said neither company has a dominant presence in the state's market.

By Nina Flanagan • April 5, 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

ACA, ICD-10 driving healthcare payer BPO market to hit $34.2B by 2022, report finds

Other key market influencers include an aging population and more insurance coverage. 

By Nina Flanagan • April 5, 2016

Government primes federal cybersecurity reporting rules for insurers

Insurers covering federal employees will have to satisfy new reporting requirements.

By Heather Caspi • April 4, 2016

Hospice provider AseraCare prevails over DOJ in twisty fraud case

Case observers say the decision was reached through a highly unusual and debatable process.

By Heather Caspi • April 4, 2016

CMS' final 2017 Medicare Advantage rates lower than expected

The updates are designed to improve payment accuracy for plans that serve dually eligible or low-income beneficiaries. 

By Ana Mulero • April 4, 2016

Humana CEO's op-ed outlines optimism for Medicare Advantage

While waiting for its acquisition from Aetna to close, CEO Bruce Broussard is touting the benefits of its 3.3 million Medicare Advantage members.

By Meg Bryant • April 1, 2016

Drug data in ACA risk pools: A wonky topic insurers, pharma & gov can agree on

Following the release of CMS white paper, insurers and pharma show support for using drug data to compare whether various patients pools' risk assessment.

By Meg Bryant • April 1, 2016

BCBSA study finds ACA patients cost 20% more

The report finds ACA enrollees to have been higher utilizers of medical services.

By Heather Caspi • March 31, 2016

How a $70M healthcare fraud can get you five years in prison

Damien Mayol received a five-year prison sentence for participating in a scheme used to develop an illegal kickback operation.

By Nina Flanagan • March 31, 2016

CAQH Index: E-admin transactions can save healthcare industry $8 billion annually

On the provider side, automated eligibility and benefits processes could save more than $5 billion every year, the nonprofit found.

By Nina Flanagan • March 31, 2016

HCA hospitals, Molina battle brewing over $88M in reimbursements

The issue, surrounding out-of-network emergency care expenses, highlights a trend in narrow network health plans.

By Heather Caspi • March 30, 2016

Anthem/Cigna merger takes heat during hearing by California insurance commissioner

Dave Jones, the commissioner of California's Department of Insurance, has to approve or reject the pending deal. 

By Nina Flanagan • March 30, 2016

Healthcare payer mergers: Pros & cons

Consolidation in the insurance industry could allow insurers to bargain with providers on more equal terms.

By Julie Henry • March 30, 2016

NYC Health + Hospitals hinges financial future on EMR, growth

On the brink of a controversial new EMR launch, the city health system is working to dig its way out of a financial hole.

By Heather Caspi • March 30, 2016

Humana study promotes wellness program benefits, increased productivity

Participants saw their health costs go down and productivity go up, the insurer says.

By Heather Caspi • March 30, 2016

SCOTUS seeks additional information for compromise on 'contraceptive mandate'

The court wants not only to allow religious nonprofits to sidestep insurance coverage for contraceptives but also make sure employees receive coverage.

By Nina Flanagan • March 30, 2016

Hospital system courts veterans in unprecedented ad campaign

Will the private sector support or compete with the VA health system?

By Heather Caspi • March 29, 2016

Medicaid enrollment surpassing expectations as ACA plans lag

Government coverage is proving popular, and ACA plans...not as much.

By Heather Caspi • March 29, 2016

CMS final rule pushes to improve mental health access, substance use services for 23M

The rule released yesterday was designed to be closely align to a 2008 mental health parity law to promote consistency in markets. 

By Ana Mulero • March 29, 2016

CMS to pilot new payment model for skilled nursing facilities

The agency wants to see if the new payment model helps reduce avoidable hospitalizations at long-term nursing facilities.

By Meg Bryant • March 25, 2016

Advocate, NorthShore's low-cost health plan aimed at allaying merger concerns

The proposed health plan would be limited to providers in the combined hospital system.

By Meg Bryant • March 25, 2016

This Text In: One question with naviHealth's Brian Fuller

What's the most important thing hospitals should be prepping to be successful with the April 1 launch of the Comprehensive Care for Joint Replacement model?

By Jeff Byers • March 24, 2016

Investigators say HealthCare.gov hit with 316 security incidents

The GAO said although there was no personal information released, the website's security flaws seem to be focused around the data services hub.

By Nina Flanagan • March 24, 2016

Telemedicine and alternative payment models: An apt fit

Will new federal regulations help make APMs and telemedicine go together like peas and carrots?

By Meg Bryant • March 24, 2016