Payer: Page 2
-
Docs say prior authorizations harm clinical outcomes
Nearly two-thirds of physicians said they wait at least one business day for prior authorization decisions from health plans, according to the report from the American Medical Association.
By Meg Bryant • Feb. 06, 2019
-
Humana rides MA wave, beats Q4 earnings expectations
The payer reported revenues of $14.17 billion for the year, compared to $13.9 billion in 2017. CFO Brian Kane attributed the growth to Medicare Advantage membership, which grew by more than 9%.
By Tony Abraham • Feb. 06, 2019
-
In hiking prices, drugmakers show some signs of tempering increases
Analysts at Raymond James found pharma price increases last month to be somewhat smaller than in January 2018 — evidence, perhaps, of some newfound restraint.
By Andrew Dunn • Feb. 06, 2019
-
Consumers aren't using health savings accounts for long-term savings strategy, study finds
Spending HSA funds on regular care leaves consumers at risk of paying out-of-pocket costs for emergencies and hospital visits, according to the report from Lively, Inc.
By Les Masterson • Feb. 06, 2019
-
AHA roadmap to rescue rural hospitals calls for regulatory relief, new payment models
Other priorities include updating Medicare and Medicaid payment rates to cover costs of care and expanding access to telehealth, according to a new report from the hospital group.
By Meg Bryant • Feb. 05, 2019
-
Anthem's PBM will trail nation's largest as it looks to compete sooner
Even though Anthem is the nation's second-largest insurer, its PBM IngenioRx will have a considerably smaller footprint out of the gate.
By Samantha Liss • Feb. 05, 2019
-
Hospital prices, not physicians, drive cost growth, Health Affairs says
The report suggests measures aimed at cutting healthcare costs focus on issues like antitrust enforcement and incentivizing more cost-efficient physician referrals.
By Shannon Muchmore • UPDATED: Feb. 5, 2019 at 1:03 p.m.
-
Centene's ACA exchange business boosts earnings
The payer raised its guidance Tuesday, expecting revenue for the year to be between $70.3 billion and $71.1 billion.
By Samantha Liss • Feb. 05, 2019
-
SponsoredNext focus for DaVinci – clinical data exchange
The DaVinci project is working to improve clinical data exchange between health plans and providers.
By Stephen Dean, General Manager, Health Plan Solutions, Veradigm
-
Judge tosses Maryland lawsuit seeking to shield ACA
Meanwhile, four more states are seeking to join an appeal defending the Affordable Care Act after a Texas judge declared it unconstitutional in December.
By Meg Bryant • Feb. 04, 2019
-
OpinionChanging how we pay for healthcare to promote high-quality care, eliminate waste
The fee-for-service model needs an overhaul to best serve patients, argue Suzanne Delbanco, Maclaine Lehan and Roslyn Murray of the nonprofit Catalyst for Payment Reform.
By Suzanne Delbanco, Maclaine Lehan, Roslyn Murray
-
Payers balk at HHS proposal to end federal PBM rebates
America's Health Insurance Plans criticized the administration's decision as "well-intentioned but misguided." The payer lobby insisted that rebate savings go directly to consumers, saving them on premiums and cost-sharing.
By Shannon Muchmore • Feb. 01, 2019
-
Cigna posts revenue jump, but Wall Street not so impressed
The payer's CEO said the change to Medicare drug rebates HHS proposed Thursday won't have "a meaningful impact" on the company or its growth, but analysts question that outlook.
By Les Masterson • Feb. 01, 2019
-
States ill-equipped to oversee short-term plans
Officials worry consumers won't be fully informed about what they're purchasing after researching short-term plans, according to a study from the Georgetown University Center on Health Insurance Reforms.
By Meg Bryant • Feb. 01, 2019
-
California sees 24% dive in new ACA plan enrollments
State officials pinned the blame on loss of the federal tax penalty for people without health insurance, but CMS pushed back on that claim.
By Meg Bryant • Jan. 31, 2019
-
Advocate Aurora, Oak Street Health partner on senior primary care
The new clinic, in a Chicago suburb with more than 25,000 Medicare-eligible adults, will offer a range of both primary care and wraparound services.
By Meg Bryant • Jan. 31, 2019
-
CMS proposes more nontraditional benefits for MA plans
If the policy changes are approved, the expected average increase in revenue for 2020 Medicare Advantage plans is 1.59%, down from the 3.4% increase for 2019.
By Shannon Muchmore • Jan. 31, 2019
-
Report says AHPs offer complex benefits, but critics not appeased
UnitedHealthcare and some Blue Cross Blue Shield brands are selling the controversial plans.
By Les Masterson • Jan. 31, 2019
-
Hospital-acquired conditions fell 13% since 2014, CMS chief says
Administrator Seema Verma touted the data Tuesday, also hinting the agency is crafting value-based payment models for states and other insurers.
By Meg Bryant • Jan. 30, 2019
-
Narrow networks can effectively control health costs, report finds
But excluding hospitals in narrow plans may harm patients who live near those facilities, according to the American Economic Association paper.
By Les Masterson • Jan. 30, 2019
-
Insurer costs vary widely in ACA exchange: GAO report
The watchdog details the factors driving business decisions for carriers selling insurance plans on the ACA marketplace and attempts to explain how costs varied and how state policies affected participation.
By Samantha Liss • Jan. 30, 2019
-
Amgen's migraine lead faces early test in CVS decision
CVS lists migraine drugs from Teva and Eli Lilly as preferred over Amgen and Novartis' Aimovig, though analysts say the effect of this formulary change will likely be modest.
By Ned Pagliarulo • Jan. 30, 2019
-
Anthem accelerates launch of PBM IngenioRx
The insurer now expects earnings to be greater than $19 per share in 2019, company executives said as they issued year-end and fourth quarter results.
By Samantha Liss • Jan. 30, 2019
-
California hospital revenue, profitability rose under ACA, Medicaid expansion
Expansion replaced nearly all county-run safety net programs in the state, according to a new National Bureau of Economic Research working paper.
By Meg Bryant • Jan. 29, 2019
-
CMS launches app showing Medicare beneficiaries what their plans cover
The app's Blue Button 2.0 functionality also lets people connect claims information to tools that "help them understand, use and share their health data," the agency said.
By Les Masterson • Jan. 29, 2019