Payer: Page 2

Q&A

ACLA seeks lab reimbursement changes as need for COVID-19 testing surges

Julie Khani, president of the American Clinical Laboratory Association, which includes Quest and LabCorp, called for eliminating testing coverage gaps and clarifications around what tests are paid for by insurers.

By Greg Slabodkin • Jan. 25, 2021

4 key trends for payers and providers in 2021

The COVID-19 crisis has led some providers to inquire about partnering or acquiring insurance assets as the pandemic exposed the risk of relying on fee-for-service models.

By Samantha Liss • Jan. 22, 2021

Explore the Trendline➔

Trendline

The Healthcare Dive Outlook on 2021

The next steps for the explosion of telehealth, the Biden administration's efforts to roll back Trump-era policies and the road back to a new normal way of doing business for payers and providers are Healthcare Dive’s big trends for 2021.

By Healthcare Dive staff

CMS expands transcatheter mitral coverage, boosting Abbott's MitraClip device

Wall Street analysts said the national coverage determination could triple the patient base eligible for the company's device that repairs leaky heart valves, adding fuel to a growing and under-penetrated market.

By Ricky Zipp • Jan. 22, 2021

UnitedHealth returns to normal care levels in Q4, posts $15B in profit for 2020

The health behemoth beat Wall Street forecasts for both earnings and revenue in the fourth quarter as care consumption and prescriptions returned to more typical levels despite fears of renewed deferrals as COVID-19 cases surge.

By Rebecca Pifer • Jan. 20, 2021

Biden faces many healthcare challenges as he takes the helm at an unprecedented time

The former senator and vice president has been sworn in as the 46th president of the United States while the country grapples with one of the biggest health crises in its history.

How Biden might shore up the Affordable Care Act

After four years of peeling away by the Trump administration, some parts will be easier to put back together than others.

By Hailey Mensik • Jan. 20, 2021

CMS rejects 1st colorectal cancer blood test, tweaks path for Exact, Guardant and others

The agency has removed one of the criteria a test needs to meet to secure Medicare coverage but still shunned Epigenomics' Epi proColon diagnostic.

By Nick Paul Taylor • Jan. 20, 2021

CMS finalizes prior authorization rule payers slam as 'half-baked'

Insurers face the biggest impact from the rule. America's Health Insurance Plans blasted it as "a series of empty promises" and "shabbily and hastily constructed."

By Rebecca Pifer • Jan. 15, 2021

'Really difficult nut to crack': MedPAC torn over telehealth regs post-COVID-19

Members were wary of making any concrete near-term policy changes, suggesting instead industry be allowed to test drive new telehealth regulations after the pandemic without baking them in permanently. 

By Rebecca Pifer • Jan. 15, 2021

Doctor on Demand partners with Texas health plan for virtual primary care HMO

The telehealth vendor has a number of virtual primary care plans in development now, including some rolling out later this year, said David Deane, head of growth and strategy.

By Hailey Mensik • Jan. 14, 2021

ACA plan enrollment for 2021 ticked up slightly

Of the total, 23% of consumers were new and the rest renewed coverage. Repeat consumers who actively chose a new plan and those who were automatically re-enrolled both increased.

By Shannon Muchmore • Jan. 14, 2021

Pandemic propels health systems to mull insurer acquisitions, partnerships: JPM21

Advocate Aurora CEO Jim Skogsbergh said "partnering for health plan capability is going to be critical to our success, and we are taking steps to do that."

By Samantha Liss • Jan. 13, 2021

CMS breakthrough rule cheered as tailwind for Abbott, J&J and Medtronic

The final rule enables developers of FDA-designated breakthrough products to get Medicare coverage for some 60 million beneficiaries on the day they win approval.

By Nick Paul Taylor • Jan. 13, 2021

Tennessee approved for first Medicaid block grant program

The waiver is approved for 10 years. The incoming Biden administration could attempt to roll it back, but the state would be able to challenge such a move.

By Shannon Muchmore • Jan. 08, 2021

With Democratic trifecta, Biden could shore up ACA

"A lot can be done with a simple majority vote in the Senate," Kaiser Family Foundation's Larry Levitt said on Twitter.

By Shannon Muchmore • Jan. 07, 2021

Kaiser Permanente ranked No. 1 in consumer satisfaction, Insure.com finds

An October survey of 2,200 consumers found a majority were generally pleased with their plans and would recommend it to others, despite 2020's historic healthcare uncertainty.

By Rebecca Pifer • Jan. 06, 2021

UnitedHealth's Optum to buy Change Healthcare in $13B deal

Change Healthcare CEO Neil de Crescenzo will become chief of OptumInsight after the deal closes in the second half of the year.

By Samantha Liss • Jan. 06, 2021

Medicaid expansion could help hospitals financially recover from pandemic, Health Affairs study suggests

Hospitals in states that expanded the safety net program under the Affordable Care Act on average saw lower uncompensated care costs and higher Medicaid revenue compared with those in states that have not, researchers found.

By Hailey Mensik • Jan. 05, 2021

Envision cut from UnitedHealthcare's network

The physician staffing firm has a significant footprint, with 25,000 clinicians in 44 states and D.C.

By Samantha Liss • Jan. 05, 2021

Centene's $2.2B deal for Magellan adds focus on behavioral health

The buy also boosts the insurer's footprint in government-sponsored health plans with the addition of 5.5 million lives and another 2.2 million to add to its pharmacy benefit management platform.

By Samantha Liss • Jan. 04, 2021

Oscar quietly readies for IPO

The startup insurer, co-founded by Josh Kushner, said the price range and size has yet to be decided. It's one of a spate of health-focused companies making the move in recent months.

By Samantha Liss • Dec. 22, 2020

CMS finalizes rule to ease value-based arrangements for prescription drugs

The changes, effective in 2022, overhaul existing regulations that stymied value-based payments in a bid to expand access to new, expensive drugs like gene therapies, the agency said.

By Rebecca Pifer • Dec. 22, 2020

ACA exchange enrollment for 2021 holds steady

About a quarter signed up for a plan for the first time — amid historic job losses — while the rest were returning customers or people who were automatically re-enrolled.

By Shannon Muchmore • Dec. 21, 2020

Provider-friendly surprise billing fix, more funds for hospitals in year-end spending bill

The final fix included in the legislation is almost exactly the same as the initial proposal greenlit last week by key congressional leaders, but includes additional concessions for providers.

By Rebecca Pifer • Dec. 21, 2020

Providers stumble in efforts to avoid HIPAA breaches: OCR

Although a survey did not find any glaring security lapses, the agency did find little adherence to some collateral safeguards, such as how patients are provided notifications regarding privacy practices.

By Ron Shinkman • Dec. 17, 2020