Payer: Page 64
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A quarter of adults in employer plans are underinsured, Commonwealth Fund says
Despite having employer-sponsored coverage, many workers are inadequately insured and have problems paying their medical bills, which could be exacerbated during the public health crisis, according to the survey.
By Samantha Liss • Sept. 9, 2020 -
Cigna expanding footprint in ACA exchanges for 2021
The Connecticut-based payer is offering plans in 80 new counties for the 2021 plan year, increasing its marketplace presence by 27%.
By Rebecca Pifer • Sept. 9, 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 -
Doctors affiliated with health systems have much higher MIPS scores, JAMA study finds
A separate study found that physicians who had the highest proportion of patients dually eligible for Medicare and Medicaid also had significantly lower performance scores than other doctors.
By Shannon Muchmore • Sept. 8, 2020 -
The White House/Healthcare Dive, data from WhiteHouse.gov
Federal COVID-19 cash saved most hospitals from bleakest forecasts: MedPAC
But any new congressional relief is stalled in Congress, and an HCA official warned cost-cutting initiatives that helped operators aren't sustainable.
By Rebecca Pifer • Sept. 4, 2020 -
CBO finds COVID-19 puts Medicare trust fund insolvency just 4 years away
The pandemic has shaved two years off the expected lifespan of the hospital insurance fund, leading Medicare experts to urge Congress to act as soon as possible to save the program.
By Rebecca Pifer • Sept. 4, 2020 -
[Photograph]. Retrieved from Regional Health Command Atlantic.
Telehealth claims dipped second month in a row in June: Fair Health
Though virtual care use remains extremely high compared to 2019, claim lines fell 21% from May to June as states began to allow in-person care once again.
By Rebecca Pifer • Sept. 3, 2020 -
Brian Tucker/Healthcare Dive
Final inpatient payment rule confirms price transparency push
CMS is also adding 24 technologies to receive add-on payments and finalizing a diagnosis-related group for CAR-T cancer therapies.
By Hailey Mensik • Updated Sept. 3, 2020 -
CMS pitches coverage of breakthrough devices in tandem with FDA authorization
The proposal follows years of AdvaMed lobbying for products awarded the special FDA designation to gain Medicare reimbursement upon clearance or approval.
By Maria Rachal , Susan Kelly • Sept. 2, 2020 -
Medicaid managed care plans' cost-controlling efforts are blunt, research suggests
Low-spending Medicaid managed care plans with no cost sharing cause broad reductions in use of services, ultimately worsening beneficiary satisfaction and health, according to a paper in the National Bureau of Economic Research.
By Hailey Mensik • Sept. 1, 2020 -
Neither Anthem nor Cigna win damages in 'corporate soap opera' merger fight
The two payers "must deal independently with the consequences of their costly and ill-fated attempt" at a $54 billion union that ultimately failed, a court ruled.
By Samantha Liss • Sept. 1, 2020 -
Aetna unveils plan nudging members to CVS clinics, pharmacies
David Balto, former policy director of the FTC, said the plan design would result in less choice and higher costs, and that with it "CVS is moving toward a restricted market approach that would only be attractive in the Soviet Union."
By Rebecca Pifer • Updated Sept. 1, 2020 -
Brian Tucker/Healthcare Dive
Allina, Minnesota Blues enter into sweeping value-based pact
The payer and provider aim to cut the cost trend for care by 10% over the next five years through the multiyear agreement, which will cover about 130,000 people.
By Ron Shinkman • Aug. 28, 2020 -
COVID-19 insurance crisis may not be as drastic as initially feared: study
A comparative analysis conducted by the Urban Institute found studies attempting to quantify how COVID-19 has affected the country's job-based insurance landscape differ wildly on methodology and conclusions.
By Rebecca Pifer • Aug. 28, 2020 -
Montgomery County Planning Commission
Aetna faces $500,000 fine over denying ER claims after repeated violations in California
A state regulator has ordered Aetna to cease and desist its practice of withholding reimbursement for emergency care.
By Samantha Liss • Aug. 27, 2020 -
MA encounter data lack essential information for fraud protection: OIG report
Medicare Advantage organizations, which cover a third of Medicare beneficiaries, already collect some of the information, but most don't submit it to CMS because it's not a requirement.
By Hailey Mensik • Aug. 26, 2020 -
Aetna turns to WellBe Senior Medical to deliver at-home care to high-risk seniors
The partnership allows the payer to tightly manage a group of patients that are likely to be more costly — seniors with multiple complex health conditions — by keeping them out of higher-cost settings like a hospital.
By Samantha Liss • Aug. 26, 2020 -
Louisiana health department wants Medicaid contract search do-over
Centene and Aetna filed protests when they were not awarded the lucrative contracts last year, and an investigation determined the awarding process was "fatally flawed." A new bidding process could end the dispute.
By Hailey Mensik • Aug. 24, 2020 -
Permission granted by BioNTech SE
Many COVID-19 cost-sharing waivers set to expire by October: study
The Kaiser Family Foundation report raises concerns more privately insured individuals could soon be exposed to steep medical costs at a time of deep economic and public health instability, even as payers report record profits.
By Rebecca Pifer • Aug. 21, 2020 -
Uber Health forays into prescription drug delivery
The rideshare company is angling for a slice of the lucrative U.S. prescription drug market through a partnership with on-demand prescription delivery platform NimbleRx.
By Rebecca Pifer • Aug. 20, 2020 -
Taylor McKnight/Healthcare Dive
Lyft claims NEMT program helps Medicaid beneficiary health access
The ridehailing giant and chief rival Uber have touted the efficacy of their non-emergency medical transportation programs, but traditional transportation brokers say they can't meet the niche needs of many U.S. patients.
By Rebecca Pifer • Aug. 19, 2020 -
Threat of financial loss main barrier to value-based model adoption: exec poll
The survey from consultancy Numerof & Associates found the healthcare industry generally supports alternate payment models, but is still falling short of actually tying reimbursement to value.
By Rebecca Pifer • Aug. 19, 2020 -
Montgomery County Planning Commission
Cleveland Clinic, Aetna team up on insurance plan, ACO
A nationwide part of the initiative will offer the payer's commercial plan members access to virtual second opinion services from Cleveland Clinic providers. They are also creating a Cardiac Center of Excellence program.
By Shannon Muchmore • Aug. 19, 2020 -
Two-fifths of working-age adults lacked reliable insurance in first half of 2020, Commonwealth Fund says
People of color disproportionately lacked comprehensive coverage and were more likely to struggle financially with medical bills, the report found.
By Rebecca Pifer • Aug. 19, 2020 -
Employers expect to boost virtual care offerings, survey finds
Business Group on Health's annual survey also found roughly 80% of respondents believe telehealth will play a significant role in how care is delivered in the future, up from 64% in 2019 and 52% in 2018.
By Hailey Mensik • Aug. 18, 2020 -
Cigna taps former Hilton exec as global CIO
Noelle Eder last held the role of EVP and chief information and digital officer at Hilton Worldwide Holdings. Prior to that, she held leadership roles at Capital One and Intuit.
By Roberto Torres • Aug. 17, 2020
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