Payer: Page 58
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Oklahoma Medicaid expansion kicks in, making eligible 190K low-income Americans
HHS Secretary Xavier Becerra congratulated the deep red state and urged the 13 remaining states that have yet to expand Medicaid to reconsider.
By Rebecca Pifer • July 1, 2021 -
Permission granted by Biogen
ICER stands by view on Biogen's Aduhelm, says sharp price cut needed
The influential nonprofit maintains that the clinical trial evidence supporting Aduhelm is insufficient to prove a health benefit. But even if some efficacy is assumed, ICER argues Biogen's $56,000 price tag is far too high.
By Ned Pagliarulo • June 30, 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 -
Anthem completes acquisition of Puerto Rico-based MA, Medicaid plans
With the buy, the payer is doubling down on its government business, which fueled the majority of its enrollment growth last year as COVID-19 pummeled the country.
By Rebecca Pifer • June 30, 2021 -
Biden administration aims to further rebuild ACA with proposed rule
The regulation would lengthen the annual open enrollment period, expand the role of navigators and nix Trump-era guidelines for waivers that were criticized for allowing states to skirt coverage requirements.
By Shannon Muchmore • June 29, 2021 -
Courtesy of Humana
Interim Humana CFO made permanent
Susan Diamond was named to the interim role in March, when the Louisville, Kentucky-based insurer's then-CFO of seven years, Brian Kane, announced plans to step down to "pursue other opportunities."
By Jane Thier • June 28, 2021 -
Sean M. Haffey via Getty Images
San Diego sues Molina, Kaiser, Centene's HealthNet over alleged 'ghost networks'
Ghost networks, provider directories that list out-of-network physicians as in-network, cause consumers to think their coverage is more comprehensive than it actually is and can make access to care even more difficult.
By Rebecca Pifer • June 28, 2021 -
Medicare lacks cyber oversight of hospitals' networked medical devices: OIG
Without proper cybersecurity controls, these devices can be compromised with the potential for patient harm, according to the HHS watchdog. OIG wants CMS to do more to address hospital vulnerabilities.
By Nick Paul Taylor • June 25, 2021 -
Half of ambulance rides could result in surprise bill, KFF finds
A ban on surprise billing kicks into effect next year, but ambulances are exempt from the legislation, meaning patients will still be on the hook for those pricey, unexpected bills.
By Rebecca Pifer • June 25, 2021 -
Missouri judge blocks voter-approved Medicaid expansion
Despite of the win at the ballot box in 2020, the state legislature failed to make funds available to expand the program to about 230,000 low-income adults.
By Samantha Liss • June 24, 2021 -
As 5 Blue Cross Blue Shield plans join to tackle drug prices, some are skeptical
Another healthcare venture promises to lower costs, this time by using patient data on drug efficacy through a handful of large insurers.
By Samantha Liss • June 23, 2021 -
Alex Wong via Getty Images
CMS releases $20M in grants to bolster state-based marketplaces
States with their own eligibility platforms have enrolled more than 3.8 million people in ACA plans so far for the 2021 plan year. Many are now eligible for lower out-of-pocket costs or reduced monthly premiums.
By Rebecca Pifer • June 23, 2021 -
Pear secures $400M to scale up digital therapeutic business in SPAC deal
The developer of the first three FDA-authorized prescription digital therapeutics has ambitions to grow sales from a projected $4 million this year to $125 million in 2023.
By Nick Paul Taylor • June 23, 2021 -
Courtesy of Siemens Healthineers
UnitedHealthcare skimping on COVID-19 test pay, California doctor group alleges
The California Medical Association says UnitedHealthcare still is not covering the cost of all COVID-19 diagnostic testing, despite state and federal guidelines that require the services to be provided at no cost to patients.
By Susan Kelly • June 22, 2021 -
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 -
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
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