Payer: Page 183
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Study questions ACA plans' sustainability when reinsurance ends
Insurers will have to count on premiums alone to cover health costs in 2017.
By Heather Caspi • April 26, 2016 -
State health exchanges report big drop in enrollment
Five states report enrollment in exchanges dropped more than 14% since open enrollment ended on Feb. 1.
By Nina Flanagan • April 26, 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 Medicaid managed care final rule caps medical-loss ratio at 85%
The rule is the first overhaul of Medicaid and CHIP managed care regulations in more than a decade.
By Jeff Byers • April 25, 2016 -
Deep Dive
New legislation aims to help rural hospitals get paid
A new measure is intended to correct a payment formula that results in low Medicare reimbursement to hospitals in rural and low-wage areas.
By Julie Henry • April 25, 2016 -
Survey: Individuals with ACA plans more likely to get care they need than those with employer plans
Enrollees in marketplace plans have similar experiences as those with an employer-based health plan, according to the Urban Institute-funded study.
By Heather Caspi • April 25, 2016 -
Employers provide free surgeries in bundled payment experiments
Some large companies beat Medicare to the game and are sharing their lessons learned.
By Heather Caspi • April 25, 2016 -
Former Capital BlueCross employee accused of $300K fraud scheme
The claims were filed with Capital BlueCross, CareFirst, and Excellus Health Plan - all members of the Blue Cross Blue Shield Association.
By Heather Caspi • April 25, 2016 -
Amateria1121 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons
Oregon health plan to exit market amid steep competition, falling revenues
LifeWise’s existing members will continue being served through the duration of their current plan year.
By Meg Bryant • April 22, 2016 -
Medicaid pays for live telehealth in most states but lack of definition creates confusion
Some states are expanding telehealth reimbursement but others are placing more limits and restrictions, a new report finds.
By Nina Flanagan • April 21, 2016 -
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 -
Anthem continues joint hospital venture efforts with 'unique' Wisconsin model
Alongside Aurora Health Care, the companies will operate the new entity, Wisconsin Collaborative Insurance Company, as 50-50 owners.
By Heather Caspi • 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
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