Payer: Page 64
-
CMS finalizes rule to ease value-based arrangements for prescription drugs
The changes, effective in 2022, overhaul existing regulations that stymied value-based payments in a bid to expand access to new, expensive drugs like gene therapies, the agency said.
By Rebecca Pifer • Dec. 22, 2020 -
ACA exchange enrollment for 2021 holds steady
About a quarter signed up for a plan for the first time — amid historic job losses — while the rest were returning customers or people who were automatically re-enrolled.
By Shannon Muchmore • Dec. 21, 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 -
Provider-friendly surprise billing fix, more funds for hospitals in year-end spending bill
The final fix included in the legislation is almost exactly the same as the initial proposal greenlit last week by key congressional leaders, but includes additional concessions for providers.
By Rebecca Pifer • Dec. 21, 2020 -
Providers stumble in efforts to avoid HIPAA breaches: OCR
Although a survey did not find any glaring security lapses, the agency did find little adherence to some collateral safeguards, such as how patients are provided notifications regarding privacy practices.
By Ron Shinkman • Dec. 17, 2020 -
Stryker, Zimmer shift strategies to capitalize on growing ASC market
Now that Medicare has caught up to private payers' expansion of coverage policies, experts see the shift toward procedures outside of hospitals accelerating. Pricing pressure is a risk, though.
By Ricky Zipp • Dec. 16, 2020 -
Samantha Liss/Healthcare Dive
Centene buys specialty pharmacy Pantherx for undisclosed sum
The acquisition was completed Wednesday. The specialty pharmacy will operate independently as part of the insurer's drug management program, as expected.
By Rebecca Pifer • Updated Jan. 4, 2021 -
Hospitals allege HHS let pharmas evade 340B drug discount rules
Led by California Attorney General Xavier Becerra, President-elect Joe Biden's pick to lead HHS, more than two dozen state attorneys general urged the agency to force drugmakers to comply with the program's rules.
By Hailey Mensik • Updated Dec. 15, 2020 -
Bipartisan agreement on provider-friendly surprise billing deal ups chance of passage
Disputes between health insurers and providers on how much to pay would be settled by an independent arbiter. The approach is favored by providers, while insurers back tying payments to median in-network rates.
By Rebecca Pifer • Dec. 14, 2020 -
CMS looks to crack down on prior authorization
The American Hospital Association cheered the news but was disappointed the proposal excluded Medicare Advantage plans.
By Samantha Liss • Dec. 11, 2020 -
Samantha Liss/Healthcare Dive
Centene closes buy of analytics firm Apixio
It's the latest step in the payer's strategy to build out its back-end technology infrastructure. Financial terms of the purchase, first announced on Nov. 9, were not disclosed.
By Rebecca Pifer • Dec. 9, 2020 -
Oak Street to expand into 2 new states early next year
As part of its 2021 growth plans, the primary care chain intends to open centers in New Orleans, along with Columbia and Greenville in South Carolina, bringing its total footprint to 13 states.
By Rebecca Pifer • Dec. 9, 2020 -
Dive Awards
Finance Trend of the Year: Going public
"The wacky aspect of 2020 is we've had tons of uncertainty and we've had a really active IPO market. And I've never seen that in my 30-year career on Wall Street," Davide Ethridge, U.S. IPO services leader at PwC, said.
By Shannon Muchmore • Dec. 9, 2020 -
Yujin Kim/Healthcare Dive
Dive Awards
The Healthcare Dive Awards for 2020
This year was unprecedented as healthcare workers around the globe battled the novel coronavirus. From those on the front lines to virtual care standout Teladoc, here are the people and companies that rose to the challenge.
By Healthcare Dive Team • Dec. 9, 2020 -
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 -
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
Previous
