Payer: Page 61
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Brian Tucker/Healthcare Dive
CMMI rolls out geographic model it calls among 'largest bets on value-based care to date'
The program will enlist direct contracting entities, which can include ACOs, health systems and provider groups or health plans, to take responsibility for the total cost of care for Medicare fee-for-service beneficiaries in their region.
By Shannon Muchmore • Dec. 4, 2020 -
iRhythm goes back to drawing board as CMS reverses national pricing move
In a departure from an August proposal, the agency will leave it up to local contractors to determine pricing for new permanent codes reimbursing the EKG patches service. Shares fell 24% after the news late Tuesday.
By Maria Rachal • Dec. 2, 2020 -
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 -
Alex Wong via Getty Images
CMS makes some telehealth coverage permanent, finalizes specialty rate cuts
The final physician fee schedule includes a significant increase to payments for evaluation and management visits, but specialty providers blasted the cuts for their services.
By Rebecca Pifer • Dec. 2, 2020 -
UnitedHealth sketches 2021 guidance, called 'a little soft,' amid COVID-19 headwinds
The insurer said it also expects membership to rise, led by its Medicare Advantage business, which could increase by nearly 14%.
By Shannon Muchmore • Updated Dec. 1, 2020 -
Payer participation in ACA exchanges rises for third year in a row: KFF
The Kaiser Family Foundation found 30 insurers joined the marketplace across 20 states, while another 61 expanded in existing regions for the 2021 plan year.
By Rebecca Pifer • Nov. 25, 2020 -
COVID-19 is making it harder for some middle income patients to pay premiums, deductibles: report
The economic impact from COVID-19 could make it harder for workers to pay for their share of employee-sponsored healthcare coverage, a survey from The Commonwealth Fund found.
By Ron Shinkman • Nov. 24, 2020 -
Craighead, Shealah. (2020). "White House Update on Coronavirus Testing" [Photograph]. Retrieved from Flickr.
Trump admin pushes last-ditch plan to lower drug prices
The American Hospital Association blasted one measure it said will significantly cut reimbursement for coming "in the middle of a pandemic with cases at record levels, and with less than six weeks’ notice."
By Jonathan Gardner , Ned Pagliarulo • Nov. 20, 2020 -
Master Sgt. Hecht, Matt. (2020). [Photograph]. Retrieved from Flickr.
Insurers, labs point fingers over COVID-19 test coverage, prices
An AHIP study of claims data is the latest volley in a debate over the cost of coronavirus diagnostics and who ultimately foots the bill. A clinical lab trade group blames "murky" tri-agency guidance for coverage denials and high costs.
By Nick Paul Taylor , Greg Slabodkin • Nov. 20, 2020 -
iRhythm wearable linked to more afib diagnoses in Aetna-backed study
Analysts were broadly encouraged by the new data, while cautioning that unlocking the market for this population will take time. Wall Street took a wait-and-see approach, with the stock closing down 9% Tuesday.
By Nick Paul Taylor • Nov. 18, 2020 -
Payers saw volumes bounce back in Q3, say COVID-19 still volatile
Companies warned tailwinds may not last as people seek previously deferred care in the fourth quarter and into next year.
Nov. 11, 2020 -
The Affordable Care Act before the US Supreme Court
The ACA has been in peril before, including before the country's highest court. But with a newly seated conservative justice, the decade-old law faces another major challenge. Here's a roundup of Healthcare Dive's coverage.
By Samantha Liss • Nov. 10, 2020 -
COVID-19 could depress 2021 Medicare Advantage payments, analysis suggests
Consultancy Avalere also warned that MA plans should brace for dealing with chronically ill enrollees whose health has declined due to foregoing care during the pandemic and could require more services in the long term.
By Ron Shinkman • Nov. 9, 2020 -
Samantha Liss/Healthcare Dive
Centene acquires analytics firm Apixio for undisclosed sum
Healthcare companies are increasingly turning to AI and machine learning tools to streamline administrative functions, with the goal of cutting down on waste and saving money.
By Rebecca Pifer • Nov. 9, 2020 -
CVS' Merlo to depart, replaced by veteran payer exec Karen Lynch
The company beat Wall Street expectations with revenue of $67 billion in the third quarter, up 3.5% year over year as its diversified book of business helped blunt the impact of coronavirus-related headwinds.
By Rebecca Pifer • Nov. 6, 2020 -
Cigna sees medical utilization bounce back in Q3
Executives had expected health spending to rise toward the end of the year as patients returned to the healthcare setting after putting off care amid the COVID-19 pandemic.
By Samantha Liss • Nov. 5, 2020 -
Biden faces a divided Congress, stifling chance for more progressive health policies
Former Vice President Joe Biden won the U.S. presidency, the Associated Press and all the major networks said, after votes were tallied in Pennsylvania on Saturday.
By Shannon Muchmore • Updated Nov. 7, 2020 -
Docs paid by ICD makers more likely to favor manufacturer: JAMA study
Yale researchers found patients were more likely to receive certain cardiac devices from the company that made the largest payment to their doctor, though quality of care did not appear to be affected.
By Susan Kelly • Nov. 4, 2020 -
Humana warns of Q4 loss amid increased COVID-19 costs, rebounding utilization
"We continue to expect our results for the second half ... to entirely offset the significant outperformance experienced in the first half of the year that resulted from historically low medical utilization levels," CFO Brian Kane said.
By Samantha Liss • Nov. 3, 2020 -
Photography by Gage Skidmore / Photo Illustration by Kendall Davis / Industry Dive
Healthcare Dive's 2020 election coverage
The outcome of the presidential race and control of the Senate were still unknown. Polling showed healthcare issues were top of mind for many as they cast their vote.
Nov. 2, 2020 -
Permission granted by Larry Bridges
Q&AThoughts on diversity in healthcare C-suite from an executive search specialist
The COVID-19 pandemic harshly exposed racial disparities in treatment and care outcomes that remain across the country, and the healthcare industry has a long way to go in diversity and inclusion among its ranks.
By Shannon Muchmore • Nov. 2, 2020 -
CMS set to bump MA rates for 2022 in win for payers
The agency is also proposing to rely entirely on encounter data to calculate patient risk scores in 2022, a move that has been opposed by commercial insurers.
By Samantha Liss • Nov. 2, 2020 -
CMS clears Georgia bid to nix Healthcare.gov, decentralizing ACA marketplace
If implemented, the state would be the first with no government-run website to enroll in ACA plans, decentralizing marketplace functions among a few private insurers. Some call it an illegal move that would push thousands off the rolls.
By Rebecca Pifer • Nov. 2, 2020 -
Molina saw members return to care in Q3, braces for curtailment as cases spike again
The payer reported it spent $35 million on COVID-19 care in the quarter. But as cases reach new heights in the U.S., it expects members to again defer care as virus costs are likely to increase.
By Samantha Liss • Oct. 29, 2020 -
Aetna to pay $1M to settle 3 patient data HIPAA breaches
The potential violations all occurred over a six-month period in 2017 and affected a total of more than 18,000 members, the HHS Office for Civil Rights said. The payer is not admiting liability.
By Shannon Muchmore • Oct. 29, 2020 -
Telehealth claim lines flat following 2 months of declines, Fair Health says
The South, which was particularly hard-hit by the COVID-19 pandemic over the summer, saw the biggest month-over-month rise in telehealth claim lines, rising 9.7%, according to the analysis.
By Rebecca Pifer • Oct. 29, 2020
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