Payer: Page 195
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CMS star ratings show mix of Medicare Advantage plan quality
More Medicare Advantage plans earned 4 stars showing private insurers are trying to meet federal standards.
By Nina Flanagan • Oct. 13, 2015 -
Deep Dive
Home healthcare at the crossroads as market expands
More at-home care plans are providing better care and reducing costs but are insurers ready to reimburse for such services?
By Nina Flanagan • Oct. 13, 2015 -
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 -
Deep Dive
Programs go beyond health in pursuit of wellness
Education assistance, financial health and more can be expected to appear in wellness programs.
By Heather Caspi • Oct. 13, 2015 -
AHA calls for passage of SMARTER Act
The bill aims to level the playing field for efforts toward hospital integration and realignment.
By Heather Caspi • Oct. 12, 2015 -
US spending more on healthcare but faring worse than peer nations
The U.S. is paying more but not getting more, researchers at The Commonwealth Fund say.
By Heather Caspi • Oct. 12, 2015 -
CMS announces 'encouraging' results from CPC initiative
The results suggest payments may be helping providers improve care coordination.
By Heather Caspi • Oct. 9, 2015 -
USDA
House to create special committee for Planned Parenthood investigation
The impact could reverberate far beyond Planned Parenthood, given the scope of the committee's authority.
By Heather Caspi • Oct. 9, 2015 -
Bill would ban Advantage plans from cutting providers mid-year
Sen. Sherrod Brown (D-OH) accuses insurers of "blatant bait and switch" when they reduce networks after enrollment.
By Heather Caspi • Oct. 9, 2015 -
Obama signs ACA small employer tweak
Republicans and Democrats played nice to update the healthcare law.
By Heather Caspi • Oct. 9, 2015 -
CMS releases massive data set on durable medical equipment costs and services
In total, the data represent over 100 million claims and $11 billion in Medicare allowed amounts.
By Jeff Byers • Oct. 8, 2015 -
Study finds complex patients tend to switch out of Medicare Advantage
The results and responses raise questions about Medicare Advantage serving patients with complex care needs.
By Nina Flanagan • Oct. 8, 2015 -
Deep Dive
Wellness programs due for privacy scrutiny, experts say
As the popularity of wellness programs spikes, people are asking what they do with all the data.
By Heather Caspi • Oct. 7, 2015 -
Brown signs first US bill to protect health brokers
The measure protects brokers from last-minute, unilateral changes to health plans.
By Jeff Byers • Oct. 7, 2015 -
NJ hospitals allege incorrect Medicare payments in CMS lawsuit
The hospitals say CMS incorrectly calculated their payments due to their services under a New Jersey charity program.
By Heather Caspi • Oct. 7, 2015 -
Oscar expanding into Texas and California in 2016
The industry disruptor is moving beyond its New York/New Jersey roots.
By Heather Caspi • Oct. 7, 2015 -
Harvard Pilgrim Health Care partners to create population health company
Benevera Health is set to begin operations on Jan. 1, 2016.
By Heather Caspi • Oct. 7, 2015 -
ACA plan premiums rising an average of 4.4% in 14 cities
The Kaiser Family Foundation is tracking and updating premium data as it becomes available.
By Heather Caspi • Oct. 7, 2015 -
Study finds ACA may shift claims from insurers to workers' comp carriers
In a move that could cost "hundreds of millions of dollars," the fee-for-service model of workers' compensation is providing case-shifting incentives.
By Heather Caspi • Oct. 7, 2015 -
Health Affairs: Plans for chronically ill cost more with Obamacare than employer
“The most popular Marketplace plan—the silver plan—has significantly higher cost sharing than does a typical employer-sponsored plan.”
By Jeff Byers • Oct. 6, 2015 -
Physicians gain 3% reimbursement boost last year thanks to ACA
States that didn't expand Medicaid in 2014 gave doctors a 3.3% reimbursement raise.
By Nina Flanagan • Oct. 6, 2015 -
Out-of-network charges average 300% more than Medicare rates, AHIP finds
Analysis finds some out-of-network treatments 1,400% higher than Medicare reimbursements but certain industry experts aren't buying it.
By Nina Flanagan • Oct. 6, 2015 -
Risk corridors program to pay insurers 13% what they're owed
The shortfall could take a toll on some insurers trying to find their footing in the exchanges.
By Heather Caspi • Oct. 5, 2015 -
Congress sends ACA small business tweak to Obama
Since the ACA was upheld over the summer, legislators are now focused on tweaking it.
By Heather Caspi • Oct. 5, 2015 -
Inadvertent Medicaid, ACA dual enrollments bring headaches
Medicaid consumers are being told they must repay any tax credits they received for ACA plans.
By Heather Caspi • Oct. 2, 2015 -
Grand jury testimony released in massive L.A. insurance scam
The macabre case involves 21 patients who say they have suffered lasting surgical scars and other injuries.
By Heather Caspi • Oct. 2, 2015
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