Payer: Page 226
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Deep Dive
To AMA, Medicare data too raw to use
Given the legitimate limitations heralded by the organization, what can the data set actually tell health care? More than you might think.
By Katie Bo Williams • June 3, 2014 -
Charity care, bad debt and the myth of 'affordable' health insurance
Some hospital systems are cutting back on financial help for uninsured, lower-income patients — and experts predict this will be a growing trend. But the assumption that this will reduce uncompensated care is far from the mark.
By Anne Zieger • June 3, 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 -
Medicare will now cover sex change surgery
The new rule is the third in a series of HHS decisions this year expanding coverage for the LGBT community. What impact will it have on private payers and Medicare's bottom line?
By Katie Bo Williams • June 3, 2014 -
CMS updates Medicare hospital charge data
The update is part of a suite of new data products released in the name of transparency — but will they be useful?
By Katie Bo Williams • June 3, 2014 -
Doc shortage to blame for Veterans scandal?
As Veterans Affairs hospitals struggle to employ enough primary care physicians to treat their expanding patient base, the department's woes highlight two important industry-wide trends.
By Katie Bo Williams • June 2, 2014 -
Two-thirds of Americans have access to ACOs
The number of accountable care organizations should double by the end of 2014, but they are still in their early development stages. Will competition force meaningful changes in care delivery?
By Anne Zieger • May 27, 2014 -
Value-based payments: Bad for the industry?
Assuming that it should become the dominant mode of health plan contracting just doesn't make sense.
By Anne Zieger • May 27, 2014 -
Charitable premium subsidies: HHS finally has an answer
The administration will permit third-party payments of premiums — but there are some caveats.
By Katie Bo Williams • May 23, 2014 -
CMS changes exchange rules to stabilize premiums
The new rule includes some pretty substantive changes, including adjustments to the risk corridors program, tougher navigator standards and others.
By Anne Zieger • May 22, 2014 -
Deep Dive
Why insurers have no choice but to hire retail execs
"Patients" are no longer "patients" — they're "consumers." And as a result, payers have to think less like insurers, and more like ... bankers?
By Katie Bo Williams • May 21, 2014 -
Obama administration approves reference pricing
The new policy represents a big change from the current system, which calls for most insurers to pay a negotiated portion of charges — and hospitals may struggle with collections as a result.
By Anne Zieger • May 21, 2014 -
Kaiser, Cleveland Clinic introduce new telehealth kiosks
"Is this my doctor or my ATM?" The new terminals will allow consumers to videoconference with a doctor, and include access to diagnostic tools and EMRs.
By Anne Zieger • May 20, 2014 -
Exchange unknowns exceed known facts, payers say
Enrolling the uninsured has been particularly difficult for payers, says one health plan CEO — and politicization of the issue isn't helping them solve the problem.
By Anne Zieger • May 19, 2014 -
Major retailers, hospital chains strengthen ties
Wal-Mart, big drugstore chains, and even some grocery chains are cutting deals with health care systems to take advantage of increased demand as more Americans obtain health insurance.
By Randy Lilleston • May 19, 2014 -
AMA letter describes Medicare data limitations
Should physicians be given the opportunity to "correct and explain" their data? The AMA thinks so.
By Katie Bo Williams • May 19, 2014 -
Deep Dive
How one insurer exposed Medicare ACOs' biggest flaw
Universal American has announced it will no longer fund unprofitable Medicare ACOs, highlighting the biggest weakness in the ACO model in the process. Is this the beginning of a trend?
By Katie Bo Williams • May 16, 2014 -
Insurers and non-profit create tool to open up cost data
The online portal represents an unprecedented partnership between Aetna, Humana and UnitedHealthcare and the Health Care Cost Institute. But will consumers use it?
By Anne Zieger • May 14, 2014 -
JAMA: Medicare spent $8.5B on needless care
Researchers analyzed claims data based on evidence-based lists of services that provide minimal clinical benefits.
By Anne Zieger • May 13, 2014 -
Medicare demands Robert Packer Hospital refund $1.9M
According to Medicare, more than a third of the examined claims had billing errors — but the hospital plans to appeal.
By Anne Zieger • May 12, 2014 -
Health insurance storefronts popular with consumers
Brick-and-mortars offer personal face-to-face time for customers, which they can't get from an online exchange.
By Anne Zieger • May 12, 2014 -
BCBS of Kansas City breach affects 2,546 members
The incident occurred when an employee inappropriately accessed member information.
By Anne Zieger • May 9, 2014 -
Health plans hiring execs with retail backgrounds
One Humana exec spent more than a decade in senior roles at Target.
By Anne Zieger • May 9, 2014 -
Most health exchange enrollees have paid first premiums
At Aetna, 500,000 out of 600,000 exchange enrollees have made an initial payment — and other insurers are experiencing similar percentages.
By Anne Zieger • May 7, 2014 -
States expanding Medicaid managed care
Florida, Texas and other states that are not expanding Medicaid under the ACA are choosing to expand Medicaid managed care programs instead.
By Anne Zieger • May 6, 2014 -
Mortality plummeted with improved coverage in MA
A study in the Annals of Internal Medicine found that five years after Massachusetts implemented health reform, there was a 4.5% drop in death due to improved access.
By Anne Zieger • May 6, 2014
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