Payer: Page 2
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Pelosi lieutenant to payers: Help us defeat Big Pharma
His words sparked a clash between policy experts and industry representatives who spoke Monday during a panel at America's Health Insurance Plans' annual conference on Medicare and Medicaid.
By Samantha Liss • Sept. 24, 2019 -
Kaiser strike called off as company, unions reach tentative agreement
Arlene Peasnall, Kaiser's interim chief human resources officer, said the company and its workforce "may disagree at times, but we have always been able to work through our challenges to align on common goals."
By Rebecca Pifer • UPDATED: Sept. 25, 2019 at 11:01 a.m. -
Judge dismisses Oscar antitrust lawsuit against Florida BCBS
Florida Blue's contract requiring brokers to sell insurance only for Florida Blue or risk losing access to all of its product lines is lawful, the federal judge wrote in his opinion.
By Rebecca Pifer • Sept. 23, 2019 -
Medicare Advantage plans see barriers to non-medical benefits
CMS allowed MA insurers to offer such benefits this year, but deployment was hampered by lack of new funding, according to a report from the Urban Institute and the Robert Wood Johnson Foundation.
By Ron Shinkman • Sept. 19, 2019 -
House Democrats forge ahead with direct Medicare drug price negotiation
While drug price constraints may still become law, House Speaker Nancy Pelosi's proposal looks like a long shot.
By Jonathan Gardner • Sept. 19, 2019 -
Tennessee unveils plan to change Medicaid funding to block grant program
The state would be the first to switch to the alternative funding mechanism if approved by federal regulators.
By Samantha Liss • Sept. 18, 2019 -
CMS mandatory radiation oncology model should be scaled back, industry argues
The model would examine effectiveness of site-neutral episode-based payments for treatment of 17 cancer types to radiotherapy providers and suppliers in randomly selected geographic areas.
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Regulatory barriers limit state alternative Rx payment models
More states are turning to alternative payment models for prescription drugs in Medicaid as they are forced to balance increasing costs with public health goals.
By Samantha Liss • Sept. 18, 2019 -
Hospitals score victory as judge tosses CMS site neutral rule
The court kicked the matter back to HHS, ordering it determine how to work out remedies for payments withheld due to the final rule.
By Dana Elfin • Sept. 18, 2019 -
Hospital market concentration on the rise, along with prices
The Health Care Cost Institute found metro areas most concentrated also had steeper increases in inpatient prices and vice-versa. The AHA pushed back.
By Shannon Muchmore • Sept. 17, 2019 -
Congress probes private equity firms financing surprise billing fight
Responses from KKR, Blackstone Group and Welsh, Carson, Anderson & Stowe are due no later than Sept. 30.
By Samantha Liss • Sept. 17, 2019 -
Dueling reports highlight payer, provider finger-pointing over healthcare costs
Three-quarters of metro areas had a highly concentrated commercial health insurance market in 2018, up from 71% in 2014, according to the study.
By Shannon Muchmore • Sept. 17, 2019 -
Health system president calls out BCBS of Massachusetts amid reimbursement squabble
Southcoast Health is looking to sign a new contract with BCBSMA to remain in-network. In a recent letter to the editor of a local newspaper, Southcoast President Keith Hovan said the payer is putting "revenues before our patients."
By Samantha Liss • Sept. 17, 2019 -
Treatment centers sue UnitedHealth unit for $5M in denied claims
The action comes on the heels of a court ruling from early this year that found United Behavioral Health's treatment guidelines were too restrictive, leading to care being denied for substance use disorders.
By Samantha Liss • Sept. 16, 2019 -
American Kidney Fund lobbies White House on charitable premium assistance
Insurers are pushing for a reexamination of policies they argue allow financially interested third parties to steer end-stage renal disease patients eligible for Medicare or Medicaid to private plans.
By David Lim • Sept. 16, 2019 -
Most nations grappling with increased healthcare cost trends
The world's most expensive healthcare is in the United States. However, other countries are also struggling with medical costs and inflation.
By Ron Shinkman • Sept. 13, 2019 -
Nursing home operator gets 20-year sentence in $1B healthcare fraud case
The government used advanced data analysis and forensic accounting to uncover the full scope of the Miami-area scheme that bilked Medicare and Medicaid.
By Dana Elfin • Sept. 13, 2019 -
Colorado union votes to strike at Kaiser, bringing 'yes' votes nationwide to 42K
The strike is scheduled to begin Oct. 14 and run for seven days.
By Rebecca Pifer • UPDATED: Sept. 17, 2019 at 9:49 a.m. -
In blow to Amazon's PillPack, Surescripts terminates contract with data startup
The move is the latest in ongoing tensions between the e-commerce giant and CVS, which, along with pharmacy benefit manager Express Scripts and two trade groups, owns Surescripts.
By Shannon Muchmore • Sept. 12, 2019 -
Employers urged to get off sidelines to trim healthcare costs
"Healthcare is not their day job. They build ships. They stock groceries," the CEO of the Pacific Business Group on Health said. "But as costs go up, they're the ones paying it."
By Rebecca Pifer • Sept. 11, 2019 -
Without much choice on ACA exchanges, will star ratings matter?
The plan rankings are coming Nov. 1, but large swaths of the country have few carriers to choose from, raising questions about the usefulness of a rankings system.
By Samantha Liss • Sept. 11, 2019 -
Insurers to deliver whopping $1.3B in ACA consumer rebates
The record amount revealed in a Kaiser Family Foundation analysis reflects how profitable payers were over the past few years, largely fueled by plans in the individual market.
By Samantha Liss • Sept. 11, 2019 -
Back in session, Congress faces industry pushback on surprise billing
Intense lobbying by industry has taken its toll on the potential for a fix, once viewed as a promising field of action with bipartisan backing and even mention from President Donald Trump.
By Shannon Muchmore • Sept. 10, 2019 -
Uninsured rate rises for 1st time since ACA
The percentage of people with public coverage fell by 0.4 percentage points between 2017 and 2018 while the percentage of Americans with private coverage did not change, according to the the U.S. Census Bureau.
By Rebecca Pifer • Sept. 10, 2019 -
UnitedHealth to link Optum's analytics, provider subsidiaries
Patients and providers will be able to access health data in real time as part of this new "digital ecosystem," Optum CEO Andrew Witty said Thursday.
By Rebecca Pifer • Sept. 05, 2019
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