Payer: Page 182
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CMS, private payers play nice, agree to 7 sets of clinical quality standards
While the new sets showcase cooperation between payers and the federal government, two national organizations have a bone to pick with two measures.
By Jeff Byers & Ana Mulero • Feb. 16, 2016 -
Zenefits probe continues: Company faces further investigation in California
Zenefits is facing more revelations related to compliance in training their workforce.
By Tom Starner • Feb. 16, 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 -
CMS to pay $7.7B for ACA reinsurance payouts
The money will certainly be needed for ACA plan carriers that took on a large number of high-cost members.
By Ana Mulero • Feb. 16, 2016 -
Study: Top ranked hospitals decreasing participation in marketplace plans
Most participate in at least one marketplace plan--but the question is for how long.
By Heather Caspi • Feb. 15, 2016 -
CBO analyzes ACA impact on private insurance premiums
The report looks at why premiums for private health insurance are "high and rising."
By Heather Caspi • Feb. 15, 2016 -
Deep Dive
Few signs employer-based health insurance is buckling under ACA
By most accounts, the workplace benefit market appears to be strong, if not thriving.
By Meg Bryant • Feb. 15, 2016 -
Cigna C-suite exec stands apart with optimistic tone for ACA exchanges
Although it continues to lose money in the marketplaces, Cigna stays positive.
By Heather Caspi • Feb. 15, 2016 -
Regulatory barriers limit access to opioid addiction medication
Federal officials are looking to address two issues that stand in the way of addiction treatment.
By Heather Caspi • Feb. 15, 2016 -
NC ACA marketplace could lose its biggest carrier
As Blue Cross is the only ACA plan that covers all 100 counties in North Carolina, more than 300,000 residents could be affected if the insurer leaves the marketplace.
By Meg Bryant • Feb. 12, 2016 -
CMS eases final rule requiring providers, suppliers to report overpayments
The agency seeks to clarify requirements for the reporting and returning of self‑identified overpayments but will insurers get behind it?
By Jeff Byers • Feb. 11, 2016 -
McKesson, HealthQX partner on bundled payment technology
The move follows on the heels of CMS' final rule for the first mandatory bundled payment program.
By Heather Caspi • Feb. 11, 2016 -
Humana reconsiders ACA exchanges after 30% Q4 profit drop
Not unlike other insurers, Humana is struggling with higher than expected medical costs for new ACA enrollees.
By Heather Caspi • Feb. 11, 2016 -
Bevin's pick for Medicaid chief has background in healthcare, finance
Stephen Miller will be tasked with scaling back the Medicaid expansion that took place under Bevin’s predecessor.
By Meg Bryant • Feb. 10, 2016 -
CMS explains new special enrollment period
A tax issue is allowing some people to take through March to sign up for ACA plans.
By Heather Caspi • Feb. 10, 2016 -
Obamacare faces quandary of 30 million still uninsured
The ACA will never achieve universal coverage, but it could get closer, experts say.
By Heather Caspi • Feb. 10, 2016 -
FDA
Possible compounding cream fraud thought to amount to half a billion
Insurers were billed as much as $10,000 for a single tube.
By Heather Caspi • Feb. 10, 2016 -
CMS pulls memo detailing possible changes to Medicare's drug reimbursements for docs
Medicare may be planning to test changes to doctors' payments for drugs under Part B, according to a memo from the Centers for Medicare and Medicaid Services. The agency said the release of the memo was "premature."
By Ned Pagliarulo • Feb. 10, 2016 -
Molina doubled profits in 2015 after Medicaid expansion
The insurer increased their membership with low-income members who gained coverage under Medicaid expansions.
By Ana Mulero • Feb. 10, 2016 -
Moda agrees to raise $179M to stay in business, removed from Oregon's reins
After a lifted state takeover of the insurer, the carrier agreed to generate $179 million to continue business.
By Ana Mulero • Feb. 10, 2016 -
HealthCare.gov could receive Covered California facelift
The Golden State's insurance exchange stands out as a potential model among active purchaser exchanges for the federal marketplace.
By Heather Caspi • Feb. 10, 2016 -
Deep Dive
Does Google really plan to be a payer?
Recent rumors have spurred industry experts to speculate what Google's entrance as a payer would look like.
By Heather Caspi • Feb. 9, 2016 -
Zenefits CEO steps down over broker compliance problems
BuzzFeed News discovered last year that the company had apparently allowed unlicensed brokers to sell insurance products.
By Kathryn Moody • Feb. 9, 2016 -
Obama's 2017 budget highlights healthcare's critical areas
On Tuesday, President Barack Obama released the 2017 budget. While the GOP declared the proposal dead on arrival, the request outlines major healthcare reform areas.
By Jeff Byers • Feb. 9, 2016 -
Novartis strikes rare P4P deals with Aetna & Cigna, will price heart med based on outcomes
In the deal with Cigna, the price of Entresto will be tied to the reduction in the proportion of planholders admitted to the hospital for heart failure.
By Ned Pagliarulo • Feb. 9, 2016 -
Could Medicaid expansion be inevitable for state holdouts?
HHS Secretary Sylvia Burwell said that certain economic drivers, like high numbers of hospital closings and unpaid services, may eventually sway the remaining 19 states to expand Medicaid.
By Nina Flanagan • Feb. 9, 2016
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