Payer: Page 55
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Record 1 in 4 Americans now covered by Medicaid, CHIP
Nearly 10 million people enrolled between February last year, a month before the COVID-19 national emergency began, and January 2021 — a 14% jump from previous enrollment stats.
By Rebecca Pifer • June 22, 2021 -
Courtesy of Walmart
OpinionBetter data sharing among MCOs, public health, Medicaid could boost vaccination efforts
The CEO of Medicaid Health Plans of America says plans are already helping states manage and respond to the COVID-19 pandemic by using data analytics and demographic information to target outreach to those most at risk.
By Craig Kennedy • June 21, 2021 -
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 CGM eligibility widened in potential boon for Abbott, Dexcom
CMS opened up coverage for therapeutic continuous glucose monitors, eliminating a rule that patients must use a blood glucose monitor and require at least four self-monitoring blood glucose tests per day to have devices covered.
By Ricky Zipp • June 21, 2021 -
The Supreme Court saved the ACA, again. It may not be the last word on challenges.
Will the 7-2 ruling put future efforts on ice? Even staunch backers of the law expect opponents to "come up with something."
By Samantha Liss • June 17, 2021 -
Alex Wong via Getty Images
Hip, knee bundled pay program results similar as voluntary or mandatory: JAMA study
The results of a University of Pennsylvania analysis of more than a million Medicare claims for joint replacement surgery lend support to CMS' expected policy shift toward more mandatory bundled payment arrangements.
By Susan Kelly • June 16, 2021 -
State employee health plans know hospitals drive most costs, but struggle to make a dent
Most states instead focus on attempting to control prescription drug costs and lower utilization, according to the Georgetown University's Center on Health Insurance Reforms' poll.
By Shannon Muchmore • June 16, 2021 -
Stefani Reynolds / Stringer via Getty Images
MedPAC: Overhaul MA payments and streamline CMMI models
The group floated changing the Medicare Advantage benchmark calculation in its annual report to Congress, while Medicaid advisers separately suggested ways to curb specialty drug prices.
By Rebecca Pifer • June 16, 2021 -
Anthem joins insurer-backed generics effort CivicaScript
The subsidiary of hospital-owned nonprofit drugmaker Civica Rx plans to initially develop and manufacture six to 10 common but pricey generic medicines that don't have enough market competition to drive down cost.
By Rebecca Pifer • June 16, 2021 -
Samantha Liss/Healthcare Dive
Centene shells out $143M to settle PBM disputes in Ohio, Mississippi
The settlement could be the first of many: The St. Louis-based payer is reserving a tranche of $1.1 billion to resolve similar claims in other states.
By Rebecca Pifer • June 15, 2021 -
Alex Wong via Getty Images
Providers ask HHS for more flexibility in deadlines to use COVID-19 relief funds
The American Hospital Association wrote that the previous guidance limiting new deadlines to funds received after June 2020 "disadvantages certain providers without providing a clear policy rationale."
By Shannon Muchmore • Updated June 24, 2021 -
Courtesy of Humana
Humana acquires Onehome to pursue value-based home health strategy
The deal for Miramar, Florida-based Onehome follows the insurer's recent purchase of home health giant Kindred at Home for $5.7 billion.
By Rebecca Pifer • June 14, 2021 -
UnitedHealthcare delays controversial ER policy following backlash
After protests from providers and medical societies, the biggest private payer is delaying the start of the policy until at least the end of the COVID-19 national emergency. But hospitals say it should be scrapped for good.
By Rebecca Pifer • Updated June 11, 2021 -
Nevada becomes second state with public health insurance option after governor OK
Washington is the only other state to enact such an insurance plan, which went live this year. Coverage under Nevada’s plan won’t begin until 2026.
By Hailey Mensik • June 10, 2021 -
Retrieved from C-SPAN on February 23, 2021
HHS warns providers, insurers COVID-19 testing must be free for patients
The American Clinical Laboratory Association, which has members including Quest Diagnostics and LabCorp, has complained that guidance on the topic had only served to muddy what it saw as clear congressional mandates.
By Greg Slabodkin • June 10, 2021 -
Industry awaits Supreme Court decision on ACA case
A ruling on the fate of the landmark law could come as early as Thursday morning.
June 9, 2021 -
A first-of-its-kind Alzheimer's drug raises heavy questions around who will and won't get it
Biogen priced its newly approved medicine Aduhelm at an average cost of $56,000 a year. Cigna, which estimates out-of-pocket costs may hit $10,000, is working on a value-based payment agreement with the drugmaker.
By Jacob Bell • June 9, 2021 -
One Medical and Iora serve radically different populations. Here's why the $2.1B tie-up might make sense.
With its multibillion-dollar acquisition of value-based Iora, One Medical is betting big on capturing longitudinal care and the profitability of risk.
By Rebecca Pifer • June 9, 2021 -
Courtesy of Walmart
Walmart, Amazon simultaneously add prescription discounts to membership perks
Walmart+ members can access some medications at zero cost and thousands of others at discounts of up to 85%. A day later, reports surfaced that Amazon is offering prescriptions for Prime members at the equivalent of $1 per month.
By Ben Unglesbee • June 9, 2021 -
Hospital lobby urges UnitedHealthcare to reverse 'dangerous' ER policy
AHA sent a letter asking the nation's largest commercial insurer to abandon a policy that denies ER visits if they are later deemed unnecessary. The policy will lead to a chilling effect on members seeking ER care, the group said.
By Samantha Liss • June 9, 2021 -
Novo keeps price in line with FDA approval of second obesity shot
The Danish company is setting the drug's list price at $1,297 a month, equivalent to its daily obesity drug Saxenda, increasing the chances insurers will cover it on a similar basis.
By Jonathan Gardner • June 7, 2021 -
Permission granted by Biogen
Deep DiveIn historic move, FDA approves closely watched, controversial Alzheimer's drug
With the decision, the agency cleared the way for what many predict will become a lucrative and highly sought-after option — though fierce debate continues over whether Biogen's aducanumab actually benefits patients.
By Jacob Bell • Updated June 7, 2021 -
Courtesy of One Medical
One Medical buying Medicare-focused Iora in $2.1B deal
The acquisition by the Google-backed primary care chain aligns two players in the value-based care movement, which eschews traditional payer-provider arrangements in favor of a concierge membership model.
By Shannon Muchmore • June 7, 2021 -
Asawin Klabma via Getty Images
Sponsored by UbiquityBuilding a social determinants of health strategy: data is the key
For managed-care plans focused on improving population health and reducing overall costs, the goal has to be on prevention, not just treatment.
June 7, 2021 -
UnitedHealthcare to crack down on ER visits, potentially exposing patients to bigger bills
If the largest private payer finds the trip was not an emergency, the visit will be "subject to no coverage or limited coverage," the provider alert states. Anthem faced backlash for a similar policy several years ago.
By Samantha Liss • June 4, 2021 -
Alex Wong via Getty Images
CMMI's Fowler: More mandatory payment models likely
"I recognize those come with their own set of disadvantages ... But I support this direction," CMMI head Elizabeth Fowler said Thursday.
By Rebecca Pifer • June 3, 2021
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