Payer: Page 2
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Geisinger's revenue, operating income up in first 9 months of FY 18
The health system attributed the growth to higher patient service and premium revenues.
By Meg Bryant • June 08, 2018
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ED visits increased nearly 10% in California after ACA
A Health Affairs study also found the chance of a Medicaid enrollee being a frequent ED user was "significantly lower" after the Affordable Care Act was signed into law.
By Les Masterson • June 08, 2018
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DOJ argues ACA pre-existing condition, individual mandates unconstitutional
The Trump administration said that with Congress zeroing out the penalty starting in 2019, the health law's individual mandate, community rating and guaranteed issue provisions cannot stand.
By David Lim • UPDATED: June 8, 2018 at 1:10 p.m.
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Study raises concerns about Medicaid managed care's narrow networks
A Health Affairs report said states need to make sure that physician turnover in narrow network plans doesn't create issues with doctor continuity for vulnerable populations.
By Les Masterson • June 07, 2018
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Bucking national trend, Pennsylvania payers seek modest exchange premium hikes
While many states worry there will be less competition in the individual market next year, Pennsylvania is seeing an uptick of participation in the exchange.
By Les Masterson • June 06, 2018
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Medicaid expansion improved care access and coverage, analysis finds
More than 30 states have expanded Medicaid under the ACA, and a few more will have the issue up for a vote this fall.
By Les Masterson • June 06, 2018
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Mandatory CMS bundles showed advantages over voluntary initiatives, report finds
A Health Affairs report found mandatory and voluntary bundled payment models "engaged different types of hospitals."
By Les Masterson • June 06, 2018
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BCBS of Texas delays unnecessary ED visit policy
The Texas Department of Insurance requested the delay and questioned the payer on the new policy.
By Les Masterson • June 05, 2018
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Payer-provider partnerships on record pace
So far this year, 22 alliances have been formed, with more than 90% using value-based reimbursement as a component.
By Les Masterson • June 04, 2018
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Losing ACA mandate penalty will reverse coverage gains, report finds
A Brookings analysis that focused on those not eligible for ACA subsidies found the individual mandate was the major reason the group got insured.
By Les Masterson • June 04, 2018
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Omission of observation stays in readmission measures misses key patient cohort, analysis suggests
The rate of 30-day readmissions for observation stays between 2007 and 2015 increased while inpatient readmissions declined, according to a New England Journal of Medicine paper.
By Meg Bryant • June 01, 2018
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AMA trumpets physician efforts in opioid epidemic fight
The doctors' group said opioid prescriptions are down while prescription drug monitoring program queries are up.
By Les Masterson • June 01, 2018
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Trump administration pushes 340B ceiling price rule to 2019
It is the fifth delay for the rule, which would also set a penalty for drugmakers that overcharge participating hospitals.
By Tony Abraham • June 01, 2018
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UnitedHealth CEO predicts dramatic hike in value-based program participation
David Wichmann told investors that the payer is focused on using its care delivery arm to push patients who don’t need emergency care toward a more appropriate setting.
By Shannon Muchmore , Tony Abraham • June 01, 2018
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Technology, value-based care driving M&A, report says
Buyers are looking for targets that can respond quickly to regulatory and market changes.
By Meg Bryant • May 31, 2018
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Industry group offers roadmap to greater provider directory accuracy
One of the first challenges is defining who is and is not a provider, according to a CAQH white paper.
By Meg Bryant • May 31, 2018
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Deep DiveDays of information blocking look numbered
Government pressure and emerging business incentives are encouraging companies to share data.
By Meg Bryant • May 31, 2018
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Healthcare groups mixed on proposed direct provider contracting model
Some groups support DPC as a way to increase access to alternative payment models, but others fear it is too redundant and encouraged CMS to fix other programs instead.
By Les Masterson • May 30, 2018
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Virginia on cusp of expanding Medicaid
The state Senate on Wednesday moved past the most significant hurdle to expand Medicaid to an additional 400,000 residents, a long-sought goal of Democrats using the powers under the Affordable Care Act.
By David Lim • UPDATED: May 31, 2018 at 9:14 a.m.
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Readmission rates among BPCI episodes show room for improvement
Groups mulling participation in the Bundled Payment for Care Improvement Advanced model may find success in targeting certain high readmission rates, according to a new report from Avalere.
By Shannon Muchmore • May 30, 2018
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WellCare to acquire Meridian for $2.5B
The deal, expected to close by the end of the year, will boost WellCare's presence in the growing Medicare Advantage market.
By Tony Abraham • May 30, 2018
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ACA health insurance tax would be delayed 2 years under bipartisan bill
Insurance companies say ending the tax would let them reduce premiums by 3%.
By Les Masterson • May 29, 2018
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Medicaid expansion sees movement in Virginia, may get vote in Idaho
Virginia could become the next state to expand Medicaid, with the state legislature expected to vote in the coming days on a plan that would tax hospitals to fund the added coverage.
By Les Masterson • May 29, 2018
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CMS plugs Medicare Advantage in beneficiary handbook draft
A version of next year's guide, which hasn't yet been published, also subtly encourages people in MA plans to request prior authorization for services and supplies.
By Meg Bryant • May 25, 2018
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California to hospitals: 'Time's up' on unnecessary procedures
Covered California is threatening to oust hospitals with high C-section rates from participating health plans' provider networks.
By Meg Bryant • May 25, 2018