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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 -
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 -
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 -
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 -
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
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