Payer: Page 2

CMS offers states more waiver options to skirt ACA requirements

Administrator Seema Verma said the move will improve affordability and consumer choice, but Democratic Sen. Ron Wyden said the proposal will promote "junk plans."

By Les Masterson • Nov. 29, 2018

Advocacy groups push back against CMS protected drugs claims

A new study undermines the agency's claim that payers lack the tools to drive down costs for drugs in protected classes.

By Samantha Liss • Nov. 29, 2018

AMA report finds less payer competition

The states that saw the largest drops in competition between 2016 and 2017 were North Dakota, Alaska, Louisiana, Indiana and Utah, according to the study.

By Les Masterson • Nov. 28, 2018

CVS-Aetna megamerger finalized

The total value of the acquisition, including assumption of Aetna's debt, clocks in at $78 billion. The union creates the second biggest private company by revenue after Walmart.

By Rebecca Pifer • Nov. 28, 2018

States debate Medicaid work requirements in wake of midterms

Virginia is the latest state to apply for a waiver, but Wisconsin's governor-elect is contemplating an end to his state's work requirement.

By Les Masterson • Nov. 28, 2018

Almost 70% of voters support protection for pre-existing conditions

More than 90% of self-identified Democrats, 79% of independents and 62% of Republicans would feel very concerned if they lost coverage for pre-existing conditions, according to the advocacy arm of the American Cancer Society.

By Rebecca Pifer • Nov. 28, 2018

UnitedHealth Group expects revenues to top $240B next year

At an investor conference in New York on Tuesday, the nation's largest commercial insurer said it expects revenues to increase at least 7.5% in 2019.

By Samantha Liss • Nov. 28, 2018

CMS aims to tackle drug costs by giving payers more bargaining power

Under the agency's proposal, Part D plans would be allowed to exclude protected drugs from their formularies in certain instances. 

By Samantha Liss • Nov. 27, 2018

Cybersecurity, telehealth, tech disruptors top health system concerns for 2019

Nearly 90% of health systems expect to increase spending on cybersecurity in the coming year, many by more than 5%, according to the Center for Connected Medicine.

By Meg Bryant • Nov. 26, 2018

UPMC sees growth in health plan enrollment, inpatient visits

The Pittsburgh-based integrated health system also reported outpatient revenue jumped 33% for the first nine months of the year.

By Les Masterson • Nov. 26, 2018

More than half of health data breaches triggered internally, study finds

Still, more than a third of the incidents are caused by theft from outsiders or unknown parties, according to an analysis of HHS data.

By Meg Bryant • Nov. 21, 2018

People with limited health insurance literacy more likely to avoid care

Plain-language communication from trusted healthcare professionals could help improve health literacy and lead to more use of preventive services, according to a new study in JAMA.

By Les Masterson • Nov. 21, 2018

Walgreens, Humana in talks to deepen partnership, WSJ reports

The two are reportedly considering taking equity stakes in the other. The news comes as payers rush to bulk up and differentiate themselves as disruptors like Amazon closely eye the sector.

By Samantha Liss • Nov. 21, 2018

CMS should give states more info to improve Medicaid MCO data reliability, GAO says

Of the eight states studied, three use an additional oversight practice to compare encounter data with an external data source and five use other mechanisms to enforce reporting requirements, including penalties, according to the watchdog.

By Les Masterson • Nov. 21, 2018

Telehealth laws inhibit widespread use in Medicare population, CMS says

The agency is opening up virtual care in some alternative payment models, but use among fee-for-service beneficiaries is just 0.25%, according to a new report. The states with the highest use are Texas, Iowa and California.

By Meg Bryant • Nov. 19, 2018

Lack of competition leads to higher ACA plan premiums in rural areas

Lower premiums in urban areas are partially related to more competition among plans and providers, according to a new report from the Urban Institute.

By Les Masterson • Nov. 19, 2018

Blockchain application still in nascent stages for healthcare, report finds

Short-term applications for the technology include back office operations and product traceability, according to CB Insights.

By Meg Bryant • Nov. 16, 2018

Atrium Health agrees to stop anti-steering practices

The case involves a relatively new target for the Justice Department — restrictions imposed by providers to limit payers from moving patients to high-quality providers.

By Les Masterson • Nov. 16, 2018

CVS-Aetna merger cleared by California's insurance regulator

The state's reluctant nod came after the entity promised not to increase premiums as a result of acquisition costs. The deal now awaits regulatory approval from four more states and is expected to close by Thanksgiving.

By Rebecca Pifer • Nov. 15, 2018

In rebound, ACA marketplace to offer more payer options in 2019

Despite concerns of more problems in 2018, ACA payers have actually found their footing — and are even enjoying profits now. Centene, Cigna, Oscar Health, Anthem and Wellmark are moving back into the market or expanding to more counties in 2019.

By Les Masterson • Nov. 15, 2018

Managed Medicaid plans treat chronic conditions on par with other commercial coverage, AHIP report finds

The payer group looked at data involving patients with asthma, diabetes and mood disorders to see how clinical care compared between Medicaid, commercial insurance and those who are uninsured.

By Les Masterson • Nov. 14, 2018

Express Scripts plans 'Flex' formulary focused on authorized generics

Gilead’s generic versions of its own hepatitis C treatments Epclusa and Harvoni are first on the list for the new formulary​, which starts Jan. 1.

By Kristin Jensen

Specialty drugs drive Rx spending increase, Blue Cross says

Insurers under the Blues' umbrella spent about $100 billion on prescription drugs in 2017, making up roughly 20% of plans' overall healthcare spending. That figure is 2% higher than it was in 2016, and has consistently risen since 2010. 

By Andrew Dunn • Nov. 14, 2018

Oscar calls foul over BCBS' exclusive broker policy in Florida

The insurer filed suit against Florida's Blue plan, alleging anti-competitive conduct over broker's sales arrangements with BCBS.   

By Samantha Liss • Nov. 14, 2018