Payer: Page 2
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PBM group says HHS drug rebate proposal would increase costs more than predicted
However, Fitch Ratings said in a new forecast it doesn't expect the change will have a long-term impact on margins or profits for payers, drug companies or distributors.
By Les Masterson • April 05, 2019 -
Amazon's Alexa now has HIPAA-compliant features
Six companies taking part in the online giant's invitation-only developer program launched their features Thursday, including Atrium Health, Cigna, Express Scripts and Livongo.
By Shannon Muchmore • April 04, 2019 -
CMS approves Maine's long-awaited Medicaid expansion
The state's voters approved expansion in November 2017 for implementation no later than July 2018. However, then-governor Paul LePage, a Republican, refused to carry out the measure last year.
By Rebecca Pifer • April 04, 2019 -
Medicaid expansion improves community health center finances, access to care
Centers in the three dozen expansion states are more likely to offer behavioral health counseling and coordinated care than non-expansion states, according to The Commonwealth Fund.
By Les Masterson • April 04, 2019 -
Industry groups seek cybersecurity safe harbor
In response to a senator's request, several organizations highlighted the need for a national strategy and greater collaboration among various stakeholders, according to a think tank that read the responses.
By Meg Bryant • April 03, 2019 -
Americans' healthcare paradox: 'angst' on costs, overconfidence on quality
Nearly 70% of Americans are "not at all" confident that politicians will be able to pass legislation to lower healthcare costs, according to a new West Health and Gallup survey.
By Rebecca Pifer • April 03, 2019 -
More care shifting from office to outpatient settings, HCCI finds
With that comes higher costs, Health Care Cost Institute researchers found. For example, the average price for a level 3 diagnostic and screening ultrasound grew 4% for office visits versus 14% in outpatient settings.
By Les Masterson • April 03, 2019 -
Cigna, Express Scripts promise to cap out-of-pocket insulin costs
Insulin manufacturers and PBMs have faced mounting pressure amid outrage over the rising cost of insulin, a nearly century old lifesaving drug.
By Samantha Liss • April 03, 2019 -
UnitedHealthcare, AMA team up on billing codes for social determinants
The two entities are developing 23 ICD-10 codes that could help address patients' socioeconomic needs by connecting them to relevant resources and social services.
By Tony Abraham • April 03, 2019 -
Premium rates increasing faster than incomes for most in US
In some states, people are spending more than one-third of their income on health insurance costs, according to a report from the Leonard Davis Institute of Health Economics and United States of Care.
By Les Masterson • April 02, 2019 -
Growth in telehealth use outpaces urgent care centers, retail clinics
Between 2016 and 2017, telehealth use jumped 53% nationwide, according to a new white paper from the nonprofit FAIR Health.
By Meg Bryant • April 02, 2019 -
CMS finalizes nontraditional MA benefits, use of encounter data
The agency is allowing MA plans to cover expenditures associated with social determinants of health, such as covering the cost of fresh produce for beneficiaries with heart disease or carpet cleaning for people with asthma.
By Tony Abraham • UPDATED: April 3, 2019 at 9:34 a.m. -
Academic medical centers face headwinds in shift to value-based care, Moody's says
To offset challenges, AMCs will need to consider partnerships that build out community physician networks and diversifying their revenue streams, according to a new report.
By Meg Bryant • April 01, 2019 -
Utah's partial Medicaid expansion cleared by CMS, sidestepping voters
The partial plan also includes work requirements, coming days after a federal judge knocked down similar mandates in Kentucky and Arkansas.
By Les Masterson • April 01, 2019 -
Employers overwhelmingly support ACA's pre-existing condition protections
The results come as the Trump administration's Department of Justice wants the courts to kill the landmark health law and its popular protections and essential benefits.
By Les Masterson • April 01, 2019 -
1 in 7 patients get surprise bill after in-network hospital care, HCCI finds
Anesthesiologists had the highest percentage of out-of-network professional claims in an in-network hospitalization, followed by primary care and emergency services, according to the Health Care Cost Institute.
By Les Masterson • March 29, 2019 -
Centene, WellCare union likely to raise antitrust concerns
The two companies both serve Medicaid beneficiaries in the same nine states and have significant overlap in certain markets, the most problematic territories being Missouri, Nebraska and Georgia.
By Samantha Liss • March 29, 2019 -
Judge rules Trump AHP expansion unlawful 'end-run' around ACA
The decision included strong words condemning the rule allowing for easier creation and use of AHPs, calling the regulatory change a "magic trick" that allowed for "absurd results" undermining the intent of Congress.
By Shannon Muchmore • March 29, 2019 -
Wyden floats adding prescription drug comparison tool to EHRs
A preliminary outline from the top Democrat on the Senate Finance Committee lacks many specifics, such as potential ramifications on EHR usability or increased administrative burden on providers.
By Rebecca Pifer • March 28, 2019 -
Killing ACA would lead to huge spikes in uncompensated care
Medicaid expansion states and those with large ACA plan enrollment would feel the most pain if the landmark law is repealed.
By Les Masterson • March 27, 2019 -
Deep DiveScale: blessing or burden for statewide ACOs?
Caravan Health launched its second statewide ACO last week. Some experts worry the scale of the models means Caravan is biting off more than it can chew.
By Rebecca Pifer • March 27, 2019 -
Centene $17B WellCare buy will boost Medicare footprint
The deal would increase Centene's size with the addition of 5.5 million lives, though analysts caution overlap or concentration could be an antitrust issue in a few states.
By Samantha Liss • March 27, 2019 -
ACA exchange enrollment dips by 300K
The decline was less than predicted amid fears of an exodus after the financial penalty for the individual mandate was zeroed out.
By Samantha Liss • March 26, 2019 -
Trump admin now backs elimination of ACA in court
The move came hours after Democratic attorneys general defending the ACA filed their brief arguing that the landmark law is still constitutional even without an effective individual mandate penalty.
By Shannon Muchmore • UPDATED: March 26, 2019 at 4:13 p.m. -
Incentivizing healthy eating could have big payoff for Medicaid, Medicare
Providing adults on the government programs a 30% subsidy on fruits and vegetables would prevent nearly 2 million cardiovascular events, according to a study in PLOS Medicine.
By Meg Bryant • March 25, 2019
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