Payer: Page 2
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More patients sidestepping ED for low-acuity problems
Despite growing use of lower-cost care options, spending for low-acuity conditions rose 14% between 2008 and 2015, according to a report published in JAMA Internal Medicine.
By Meg Bryant • Sept. 06, 2018
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JAMA studies show upsides of CMS bundled payment models
The reports found reduced institutional post-acute discharges with the CJR program and no increase in patient volume for the BPCI model.
By Les Masterson • Sept. 06, 2018
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PhRMA, hospital war over drug prices heats up
The drugmaker lobby issued a report contending hospitals upcharge meds by 500% as a hospital-led effort to develop cheaper generics took a step forward.
By Rebecca Pifer • Sept. 06, 2018
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WellCare's Meridian purchase boosts Medicaid market share
When Tampa, Florida-based WellCare announced the deal in May, it said the transaction would put it in the leading Medicaid market position for six states.
By Les Masterson • Sept. 05, 2018
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Gottlieb: UnitedHealth, CareFirst sign onto FDA pilot aiming to speed device coverage
The FDA chief also outlined new programs including "QUiK Review" aimed at cutting review times for well-understood, low-risk 510(k) submissions "by as much as 30%."
By David Lim • Sept. 05, 2018
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Amazon's stock valuation hits $1T
Outside of the strictly retail space, Amazon is rushing into healthcare headfirst with new hires and acquisitions as well as its joint venture with Berskhire Hathaway and J.P. Morgan.
By Ben Unglesbee • Sept. 05, 2018
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Cigna names chief data and analytics officer
The appointment comes as the insurer attempts to swallow pharmacy benefits manager Express Scripts.
By Susan Kelly • Sept. 05, 2018
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Novartis CAR-T therapy snags UK coverage, cutting list price 23% from US
One of the fastest funding deals in the country's history leaves Novartis well ahead of rival Gilead in the battle to secure U.K. commercial returns.
By Andrew Dunn • Sept. 05, 2018
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Amazon-Berkshire-JPM healthcare venture picks COO
Jack Stoddard, previously of Comcast and UnitedHealth, is CEO Atul Gawande's first publicized hire as the company works to fill the highly hyped effort's executive suite.
By Rebecca Pifer • Sept. 05, 2018
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Aetna to cover Abbott's non-opioid pain implant Proclaim
The decision opens up a potential market of 22 million people for the neurostimulation device.
By Nick Paul Taylor • Sept. 05, 2018
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Medicare ACOs saved $1.1B in 2017, CMS data show
It comes after CMS officials predicted an overhaul of the Medicare Shared Savings Program would push ACOs to take on more financial risk in their first years of participation.
By Les Masterson • Sept. 04, 2018
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CMMI director says agency won't force all providers to assume risk
Adam Boehler said, however, that CMS wants to "create that avenue" for any practices interested in taking on more risk.
By Rebecca Pifer • Aug. 31, 2018
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CMS looks to develop consumer comparative pricing portal
The agency has been pressing hospitals to be more transparent about the costs of procedures and services.
By Meg Bryant • Aug. 30, 2018
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Tennessee health system lawsuit alleges rigged Medicaid contracting by state
The filing is the latest breadcrumb in a trail of litigation reaching back to 2007.
By Rebecca Pifer • Aug. 30, 2018
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Uninsured rate stays stable in 2018
Use of high-deductible health plans continued an upward trend, with nearly half of people with private insurance saying they have such coverage, new federal statistics show.
By Les Masterson • Aug. 30, 2018
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Deep DiveBlockchain in healthcare: Huge promise, but largely unproven
"What blockchain has been able to do is create markets where a market didn't previously exist," says Noah Zimmerman, director of Mount Sinai's Center for Biomedical Blockchain Research.
By Meg Bryant • Aug. 30, 2018
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Report offers framework for assessing EHR usability, safety
The voluntary roadmap includes criteria examples for developers and providers to use in testing EHR products at each lifecycle stage.
By Meg Bryant • Aug. 29, 2018
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Payers saw more upgrades in H1 2018, A.M. Best says
The credit rating agency attributed the wide swath of upgrades to improved performance in the ACA exchanges and heightened profitability for many insurers.
By Rebecca Pifer • Aug. 29, 2018
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Hundreds of groups raise concerns about E/M payment proposal
They support efforts to cut provider administrative burden in the 2019 Physician Payment Rule but question its consolidation of office billing codes.
By Les Masterson • Aug. 29, 2018
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Health insurance tax return would increase out-of-pocket costs, report finds
Congress approved a one-year moratorium on the tax for 2019, but it is expected to return the following year.
By Les Masterson • Aug. 29, 2018
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Humana announces new center for digital health, analytics
One focus of Humana Studio H in Boston will be developing new health experiences for seniors.
By Meg Bryant • Aug. 28, 2018
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Nixing discharges to long-term care hospitals could save Medicare $4.6B, study finds
Long-term care hospitals are reimbursed at substantially higher rates than other post-acute care arrangements.
By Meg Bryant • Aug. 28, 2018
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Critics say GOP pre-existing conditions bill flawed
The legislative effort comes as a Republican-backed court case may wipe out the ACA's protections for people with pre-existing conditions.
By Les Masterson • Aug. 28, 2018
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Next-Gen ACOs saved $62M in first reporting year, CMS says
Half of the drop in spending and utilization stemmed from just four of the 18 NGACOs active in 2016, according to a report from the agency.
By Meg Bryant • Aug. 28, 2018
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Clover Health expanding MA offerings to 6 more markets
The San Francisco-based payer also announced it is working with Taiwan-based Cathay Life Insurance to use artificial intelligence products that can predict elements like what patients will need hospitalization and when.
By Les Masterson • Aug. 27, 2018