Payer: Page 181
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CMS dumps litany of Medicare payment changes for skilled-nursing facilities, rehab, hospice care
The agency also proposed an assessment-based quality measure and three claims-based measures to help satisfy the requirements of a quality-reporting program for SNFs.
By Jeff Byers • April 21, 2016 -
UnitedHealth nets $19.7B with Optum earnings
While the insurer plans to exit at least 18 ACA state markets next year, Optum's earning show UnitedHealth will be fine without the individual coverage revenue.
By Heather Caspi • April 20, 2016 -
2016 ACA plans provide better drug access for complex diseases
CMS guidance may have helped turn the tide from 2015's adverse tiering.
By Heather Caspi • April 20, 2016 -
CMS details racial disparities under Medicare Advantage
Asians and Pacific Islanders typically received care "similar to or better than the care received by whites," the agency found.
By Heather Caspi • April 20, 2016 -
EmblemHealth employees stage protest after 250 layoff notices confirm IT outsourcing
CEO Karen Ignagni said outsourcing the work was part of "crucial" modernization for the company's future.
By Naomi Eide • April 20, 2016 -
Analysis predicts limited impact from UnitedHealth ACA departures
Even a total departure would have a modest impact nationwide, experts predict. However, such a move could negatively impact rural markets and southern states.
By Heather Caspi • April 19, 2016 -
Deep Dive
Strategies small medical practices should consider in the face of industry change
Collaboration is the key, some experts say.
By Julie Henry • April 19, 2016 -
Deep Dive
Surprise medical bills: Who should cover the costs?
Parties disagree as to whether insurers should cover the extra costs or providers should bill at in-network rates.
By Julie Henry • April 19, 2016 -
GOP legislators blast CMS for prioritizing reinsurance
The argument centers around a CMS rule that's putting reinsurance payments before Treasury payments.
By Heather Caspi • April 19, 2016 -
UnitedHealth to remain only in 'handful' of ACA markets next year
The announcement comes as the Obama administration downplayed the potential actions of one health insurer, albeit the nation's largest.
By Jeff Byers • April 19, 2016 -
CMS chops controversial two-midnight rule payment cut
The agency has additionally proposed to offset the fiscal effects of the policy from the last three years.
By Jeff Byers • April 19, 2016 -
How a tech glitch caused 1.9K pregnant women to lose their Covered California coverage
Some women would be best not to report their pregnancy if they want to keep their health plan through the state's marketplace until the flaw is fixed.
By Nina Flanagan • April 19, 2016 -
Health Affairs: Next Gen ACO model not to be overlooked
The national Next Gen ACO model is the most attractive being offered today, bloggers argue.
By Heather Caspi • April 18, 2016 -
Future of Cadillac Tax to get bipartisan discussion
Though delayed, the controversial provision still looms ahead.
By Heather Caspi • April 18, 2016 -
UnitedHealth to drop out of Michigan ACA marketplace in 2017
The decision marks the third individual-coverage market the insurer will exit next year.
By Ana Mulero • April 18, 2016 -
Humana's wellness program to rebrand as 'Go365'
The program will offer members a more personalized approach to their health beginning January 2017.
By Heather Caspi • April 18, 2016 -
Thinking of starting a provider-led health plan? Ask these four questions
In a recent analysis, 40 of 89 provider-led health plans had negative margins during the past three years.
By Meg Bryant • April 15, 2016 -
Elizabeth Regan/Healthcare Dive
ACOs show modest savings in first full year
Organizations in the Medicare Shared Savings Program were able to maintain or improve certain care performance measures.
By Meg Bryant • April 15, 2016 -
Individual market to look up after 2017, analysts predict
In 2014, insurers lost about $3 billion in the marketspace but it could become more viable as insurers gain experience pricing their products.
By Heather Caspi • April 14, 2016 -
HHS report debunks fear of a double-digit Obamacare premium increase
As 67% of HealthCare.gov consumers opted for a new plan in 2016, HHS states premiums depend on market dynamics as a whole, not just payer pricing decisions.
By Meg Bryant • April 13, 2016 -
Insurers' experience all over the map during first ACA risk adjustment year
An analysis by the American Academy of Actuaries states premiums need to reflect the level of risk in an entire market pool, not just insurers' beneficiaries.
By Meg Bryant • April 13, 2016 -
Deep Dive
Insurers take on obesity prevention
Many insurers are going above and beyond with both local and national obesity prevention efforts.
By Julie Henry • April 13, 2016 -
Humana flub tells 12K people their drugs not FDA approved
The incident impacted a portion of Humana's Texas enrollees.
By Heather Caspi • April 13, 2016 -
Health insurers pay for obesity -- one way or another, experts say
The cost of denying obesity care could exceed that of providing it, experts say.
By Heather Caspi • April 13, 2016 -
Short-term health policy sales surge despite plan limitations
Those who develop health problems can always switch to a ACA plan to cover pre-existing conditions, insiders note.
By Nina Flanagan • April 12, 2016
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