Payer: Page 55
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FDA's real-world evidence push hampered by data challenges, 'million-dollar question'
While the agency wants to tap information like electronic health records and wearables to make pre- and postmarket decisions, these sources do not have the same quality controls as clinical trials.
By Greg Slabodkin • Oct. 4, 2021 -
MA premiums will dip as payers expand footprints
Cigna, UnitedHealth and Centene are all entering new areas for 2022, but analysts say benefit options show that bids from insurers are relatively conservative.
By Shannon Muchmore • Updated Oct. 5, 2021 -
Explore the Trendline➔
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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 -
Samantha Liss/Healthcare Dive
Centene reaches $72M settlement with Illinois, Arkansas for alleged Medicaid overcharges
The two states allege Centene failed to disclose relevant discounts and inflated dispensing fees. The latest settlements come months after similar agreements were reached in Ohio and Mississippi.
By Samantha Liss • Oct. 1, 2021 -
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Surprise BillingDoctors slam surprise billing rule that details dispute resolution process
The interim final rule established that existing rates in a provider's geographic area will be a strong anchor for final payment decisions by arbitrators.
By Shannon Muchmore • Oct. 1, 2021 -
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Consumer satisfaction with telehealth fell from last year, J.D. Power finds
Among direct-to-consumer brands, Teladoc ranked highest for consumer satisfaction, followed by MDLive. Among payer-sponsored services, UnitedHealthcare ranked the highest.
By Hailey Mensik • Sept. 30, 2021 -
AMA calls out shrinking payer competition amid rising antitrust interest in Washington
The study by the physician group is the latest salvo in a messaging war between provider and payer lobbies as they work to shift the blame for rapidly rising medical costs.
By Rebecca Pifer • Sept. 29, 2021 -
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CMS defends proposal to nix MCIT pathway, but medtechs hold out hope
If the bid to repeal the breakthrough payment rule is finalized, the agency's CMO committed to an alternative pathway that evaluates devices for Medicare patients potentially via clinical trials, outcome registries and real-world data.
By Greg Slabodkin • Sept. 29, 2021 -
Free insurance under COBRA for Americans without job-based coverage ends Thursday
Experts say there was huge demand for the six-month subsidy, with one estimate finding more than 16 million people lost their employer-sponsored health insurance during the pandemic.
By Rebecca Pifer • Sept. 29, 2021 -
Lance Cheung. (2018). "20180927-RD-LSC-0093" [Photograph]. Retrieved from Flickr.
OpinionBroadband investments can improve health, as long as insurers don't roll back telehealth coverage
Jason Resendez of Consumers for Quality Care argues it's time for insurers, policymakers and health systems to embrace telehealth as an integral part of the future of healthcare.
By Jason Resendez • Sept. 27, 2021 -
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Sponsored by ZSHealthcare 2025: Health plans look ahead to emerging business opportunities
Eager to learn how health plans view their role and other stakeholders in the overall healthcare ecosystem today?
Sept. 27, 2021 -
Centene, Humana sue Merck for 'monopolistic scheme' to delay generics of blockbuster cholesterol drug
The suits allege an agreement between Merck and a generic manufacturer kept lower-cost versions of the drugmaker's widely used pill Zetia off the market for years.
By Samantha Liss • Sept. 24, 2021 -
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State Medicaid officials face daunting fall season amid low vaccination rates, record enrollment
Telehealth and behavioral health service needs are also a challenge as the COVID-19 pandemic drags on and the Biden administration encourages more people to get on the rolls.
By Hailey Mensik • Sept. 23, 2021 -
Courtesy of Cigna
Cigna expands purview of global CIO
Noelle Eder, who first joined the company in August 2020, will add data and analytics to her role.
By Roberto Torres • Sept. 23, 2021 -
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Payers double down on population health programs amid COVID-19
Keys to successful interventions include good data, local connections and realistic ROI expectations, payer executives said Tuesday at AHIP's annual conference on Medicare, Medicaid and dual eligibles.
By Shannon Muchmore • Sept. 22, 2021 -
OIG flags potential $5B overpaid to Medicare Advantage plans
The watchdog calls out 20 private insurers, which it does not name, and urges CMS to conduct greater oversight.
By Samantha Liss • Sept. 22, 2021 -
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Second dose of J&J's coronavirus vaccine increases protection, company says
Long-awaited results from a Phase 3 study run by J&J could support use of a booster dose, although the drugmaker has not officially applied for FDA clearance yet.
By Shoshana Dubnow • Sept. 21, 2021 -
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Sponsored by ZelisYour guide to addressing claims pre-payment to maximize savings
Read more in this guide to discover strategies for high-cost claim optimization.
Sept. 20, 2021 -
Pandemic special enrollment period led to record number of ACA enrollees
Legislation passed earlier this year also expanded premium tax credits and helped drive down premiums. More than 90% of those who enrolled during the SEP saw their premiums reduced.
By Hailey Mensik • Sept. 16, 2021 -
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Private health coverage for working-age adults fell amid pandemic, Census data shows
The drop from March 2019 to March 2021 was largely offset, however, by coverage gains in programs like Medicaid.
By Susan Kelly • Sept. 15, 2021 -
In rare move, DOJ intervenes in MA fraud case against data mining company
Defendants Independent Health, an MA payer, and its now defunct medical analytics subsidiary DxID denied all allegations of wrongdoing and said they planned to defend themselves "vigorously" in court.
By Rebecca Pifer • Sept. 15, 2021 -
Montgomery County Planning Commission
In lawsuit, former employee blows whistle on Aetna's alleged fraudulent provider network that listed dead physicians
The plaintiff discovered that "tens of thousands of children were assigned to [primary care providers] that had no relationship whatsoever to [Aetna]," the suit alleges.
By Samantha Liss • Updated Sept. 15, 2021 -
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Preventable hospitalization costs among unvaccinated patients surged to $3.7B in August, KFF says
More than 280,000 hospitalizations from COVID-19 between June and August could have been prevented by vaccination, researchers found.
By Rebecca Pifer • Sept. 14, 2021 -
Courtesy of Humana
Humana's reported rise in hospitalizations among seniors is a trend worth watching
It's potentially troubling because people who are eligible for Medicare have a higher vaccination rate than the rest of the population. Humana's report raises questions about what's driving the uptick in hospitalizations among this cohort.
By Samantha Liss • Sept. 13, 2021 -
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Biden pushes forward on Medicare price negotiation
But opposition from the drug industry and Republicans could make the Democrats' signature proposal an uphill battle.
By Jonathan Gardner • Sept. 13, 2021 -
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Insurers to disclose relationships with brokers, agents in new CMS proposed rule
Other proposals would require air ambulances to disclose additional data to HHS and outline how CMS can enforce surprise billing protections if states fail to act.
By Rebecca Pifer • Sept. 13, 2021
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