Payer: Page 187
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Deep DiveFriday Rounds: Wheelin', dealin' and leavin' in the new year
The healthcare industry didn't waste any time kicking off the new year. Federal actions framed the week as one major insurer left the trade group AHIP.
By Jeff Byers • Jan. 8, 2016 -
LA governor sets ambitious plan for Medicaid expansion
Despite budget issues, the incoming democratic leader is targeting a summer expansion deadline.
By Heather Caspi • Jan. 8, 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 -
Federal watchdog warns of waste, lack of controls in ACA tax credit payment program
In response, CMS is pilot testing an automated process to address tax credit payments concerns.
By Meg Bryant • Jan. 7, 2016 -
Americans struggle to pay health bills even when insured
More than a quarter of insured Americans in a recent survey said unexpected claim denials made it difficult to pay medical bills.
By Meg Bryant • Jan. 7, 2016 -
Health Affairs Blog: Standardized option for plans may benefit consumers, reduce discrimination
Standardized options would provide fixed deductibles, out-of-pocket limits, and standard copays and coinsurance for a number of essential health benefit services.
By Nina Flanagan • Jan. 7, 2016 -
Montgomery County Planning Commission
AHIP suffers major blow as Aetna departs
The company will not renew membership for 2016, marking a second hit to AHIP after United Health left last summer.
By Heather Caspi • Jan. 6, 2016 -
California approved for $6.2B Medicaid waiver
The state will be able to continue the massive transformation of its state Medicaid program.
By Heather Caspi • Jan. 6, 2016 -
Critical illness plans fill voids of skimpy health plans
Lump sum deals are being used to supplement otherwise high cost plans.
By Heather Caspi • Jan. 6, 2016 -
HIPAA rule change aims to limit gun access
HHS’ HIPAA privacy rule update will allow mental health providers to identify patients subject to a mental health prohibitor barring them from shipping, transporting, or possessing firearms.
By Meg Bryant • Jan. 6, 2016 -
Uninsured hospital stays fell sharply in states that expanded Medicaid, study finds
New research published in Health Affairs could help influence states on the fence over expanding Medicaid programs.
By Jeff Byers • Jan. 5, 2016 -
Deep Dive
Health insurers look toward breaking down the big data walls
Siloed data are big barriers when it comes to health plans utilizing big data, but starting small and adding clinical value could provide the ROI insurers are looking for.
By Heather Caspi • Jan. 5, 2016 -
ACA plans comp doctor visits to attract patients
Some marketplace health plans are using the tactic to stand out and, hopefully, lower costs down the line.
By Heather Caspi • Jan. 5, 2016 -
CMS, ONC open suggestion box on quality data submission
The agencies are looking to reduce the reporting burdens on providers and developers.
By Heather Caspi • Jan. 4, 2016 -
CMS releases draft plan on quality measure development
Quality measures for new payment models will further promote provider accountability.
By Heather Caspi • Jan. 4, 2016 -
New Kentucky governor scales back stance on Medicaid expansion reversal
Stating the current incarnation is unsustainable, Gov. Matt Bevin (R) is exploring an ACA federal waiver option as opposed to dismantling the expansion entirely.
By Heather Caspi • Jan. 4, 2016 -
Deep Dive
Keeping an eye on the prize: 8 healthcare topics to watch in 2016
From the 2016 presidential election to behavioral healthcare, the industry has its work cut out for it this year.
By Nina Flanagan • Jan. 4, 2016 -
CMS pushes back against risk score 'zombification'
The ACA's risk adjustment program, which shifts money between insurers, hinges on risk score credibility.
By Heather Caspi • Dec. 23, 2015 -
CMS online tool reveals Medicare drug spending disparities
The agency, while noting prescription drug spending increased by 12% in 2014, has launched a digital dashboard for the public to view drug spending and usage trends.
By Heather Caspi • Dec. 23, 2015 -
Deep Dive
8 takeaways from healthcare's 2015
From collapsing health co-ops and megamergers to the "Uber of healthcare," 2015 wasn't short on industry thrills and spills.
By Jeff Byers • Dec. 23, 2015 -
Three big insurers gain most Medicare Advantage members
If the Aetna acquisition of Humana goes forward, the combined organization would be the largest Medicare Advantage company in the U.S.
By Nina Flanagan • Dec. 22, 2015 -
Deep Dive
How regulations changed reimbursement in 2015, outlooks for 2016
Three industry experts weigh in on the changing reimbursement regulations, including their effects on Medicare Advantage and payer costs.
By Heather Caspi • Dec. 22, 2015 -
Private health exchanges puts employees in driver's seat to choose benefits
The rising model is, with expanded offerings like wellness and life benefits, are increasingly attractive for many competitive small and mid-sized companies.
By Heather Caspi • Dec. 22, 2015 -
Colorado to vote on single-payer healthcare in 2016
Whether or not residents like the plan, they may not like its pricetag.
By Heather Caspi • Dec. 22, 2015 -
CMS releases fee-for-service data on home health agencies
The data, which identifies individual agencies, are provided for transparency.
By Heather Caspi • Dec. 21, 2015 -
As Medicaid expands, so does room for error
Program expansion is leading to improved outlooks for some insurers, but nearly doubling the rate of improper payments.
By Heather Caspi • Dec. 21, 2015
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