Payer: Page 225
-
Health exchange subsidies cut premiums by 76%
...but premiums vary from state to state, as well as the size of the subsidies and proportion of beneficiaries who qualify for financial help.
By Anne Zieger • June 19, 2014 -
Former ONC chief launches well-funded ACO startup
Aledade will help independent physicians form and join accountable care organizations, but are they cutting themselves out of a large part of the market?
By Katie Bo Williams • June 18, 2014 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
HHS to limit orphan drug exclusions despite court ruling
The agency stands by its interpretation of the statute requiring drugmakers to offer discounts to hospitals on orphan drugs when used for common conditions.
By Katie Bo Williams • June 18, 2014 -
Report: US healthcare ranks last in pretty much everything
The lead researcher called the findings "disappointing but not surprising."
By Katie Bo Williams • June 17, 2014 -
UnitedHealth continues to drop Medicare Advantage providers
The insurer says that network restructuring is "the new normal." Meanwhile, tentative legislation in Washington would prohibit plans from cutting physicians mid-year.
By Katie Bo Williams • June 17, 2014 -
Rural hospitals get Medicare pay adjustments — for a little while
This is good news for the nation's small, rural hospitals facing their own brand of financial pressures. But is it just another "patchwork" fix?
By Judy Packer-Tursman • June 17, 2014 -
It's time for hospitals to add retail clinics
Clinics would provide patients with the level of assistance they actually need and get hospitals away from the expensive and often wasteful emergency room model for routine care.
By Anne Zieger • June 17, 2014 -
Boeing is first customer for employer-driven ACO
Two health systems in Washington state are working directly with employers to customize coverage products, and the airline giant is only the beginning. But does this kind of relationship limit consumers' choices?
By Judy Packer-Tursman • June 16, 2014 -
Deep Dive5 TED Talks every healthcare exec needs to watch
TED Talks consistently produce some of the most innovative thinking in healthcare. Take a look at the five most important speakers over the last few years who echo the ideas leading executives are talking about.
By Katie Bo Williams • June 16, 2014 -
Deep Dive
Medicaid ACOs on the rise, despite challenges
With 19 states now using some form of a Medicaid ACO, the model comes with both promises and challenges.
By Judy Packer-Tursman • June 16, 2014 -
OIG demands $9.8M Medicare refund extrapolated from few claims
The audit revealed that about half of an Ohio hospital's 228 claims under review were compliant. But the rest of the claims spelled big trouble — after auditors extrapolated the hospital's penalty into the millions.
By Judy Packer-Tursman • June 16, 2014 -
Enrollment in private exchanges rising
Providers can expect to see a much higher percentage of out-of-pocket collections from patients with employer-based coverage as a result.
By Katie Bo Williams • June 12, 2014 -
Medicare poorly tracks hospital infections
Hospital infections continue to pose both health risks and heavy financial costs. And tracking them, according to a new study, is "an imprecise science." Just how big is the impact of hospital complications?
By Judy Packer-Tursman • June 12, 2014 -
New payment models to surpass fee-for-service by 2020
The new study by McKesson suggests two-thirds of payments will be value-based in less than 10 years — which worries providers much more than payers.
By Judy Packer-Tursman • June 12, 2014 -
'Dr. Google' is here to stay: The future of patient-physician relationships
Physicians might resent patients who self-diagnose, but nothing is going to change the trend toward the digital sharing of information between clinicians and consumers.
By Anne Zieger • June 11, 2014 -
MD exchange reports proposals for double-digit 2015 premium hikes
...while other proposals call for premium decreases. Is Maryland's dominant insurer seeing sicker-than-average new members this year? Are other plans seeking lower rates just to compete or are their members healthier?
By Judy Packer-Tursman • June 10, 2014 -
Deep Dive
The Highmark Health gamble: How risky is insurer-hospital integration?
After purchasing a Pennsylvania health system, Highmark Health posted a $186 million loss in 2013 and may lose the leading area provider from its network. What happens next, and what does the Highmark story mean for the trend of vertical integration?
By Judy Packer-Tursman • June 9, 2014 -
CVS dominates retail clinic market (but for how long?)
There's still plenty of room for everyone, a new report says. Even with its market dominance, CVS only has clinics in 10% of its stores nationwide, leaving room for hospitals, insurers and other retail companies to open up shop.
By Judy Packer-Tursman • June 5, 2014 -
3M Medicaid applicants stuck in limbo
The Obama administration is boasting the success of Medicaid expansion under reform, but technical glitches and a surge of applications have woefully backlogged enrollment. How will this impact providers?
By Judy Packer-Tursman • June 5, 2014 -
Why consumers are ignoring health cost data
The industry push for transparency is based on the theory that high deductibles will drive patients to get more involved in health pricing and quality... but that may be a false assumption.
By Anne Zieger • June 5, 2014 -
AHA calls for halt of OIG compliance reviews
Are Office of Inspector General audits "redundant" to the Recovery Audit Contractor program? The AHA thinks so — and claims they are an unfair and expensive burden on hospitals.
By Judy Packer-Tursman • June 5, 2014 -
Are Medicare Advantage plans being overpaid by billions?
Another study says "yes," blaming unjustifiably high risk scoring for plan members — but the industry fires back. Is the increase in risk scores due to MA plans' aggressive billing or a sicker patient population?
By Judy Packer-Tursman • June 5, 2014 -
Medicaid expansion boosts some hospitals' revenue
And the numbers are striking. One hospital in Seattle expects to see an additional $20 million this year alone — double its initial projection.
By Judy Packer-Tursman • June 4, 2014 -
Medicare to cover hepatitis C screening, but not in the hospital
With 17,000 Americans infected annually, CMS wants to protect adults from the virus — if they go to the right care setting.
By Judy Packer-Tursman • June 4, 2014 -
Medicare Advantage bids hint at 2015 changes
Health plans submitting Medicare bids by the June 2 deadline faced tough choices, and the result is shrinking provider networks, premium hikes and benefit cuts.
By Judy Packer-Tursman • June 3, 2014
Previous
