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Adeline Kon/Healthcare Dive/Healthcare Dive
What to watch as health systems and insurers report Q1 results
For both payers and providers, volumes will be an important metric. The lingering question is how quickly patients will return to in-person care.
By Samantha Liss , Shannon Muchmore • April 20, 2021 -
Alex Wong via Getty Images
Value-based care at 'critical juncture,' new CMMI chief says
Even though some testing payment models have been delayed or discarded, CMMI's new leader said the agency remains committed to finding models that reward value not volume.
By Rebecca Pifer Parduhn • April 20, 2021 -
Courtesy of Humana
Humana nets nearly $200M in overpayments, OIG audit finds
The watchdog said the payer submitted documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were.
By Samantha Liss • April 20, 2021 -
UnitedHealth kicks off Q1 earnings season with 44% profit jump
Care was still muted in the first quarter even as vaccinations ramped up and states lifted restrictions, contributing to the healthcare behemoth's $4.9 billion bottom line.
By Rebecca Pifer Parduhn • April 15, 2021 -
Anthem, Blackstone, digital health startup K Health launch joint venture to curb costs
Financial terms of the deal were not disclosed, but the new venture, which has been in the works for years, will use AI tools in an attempt to better triage patient care.
By Rebecca Pifer Parduhn • April 14, 2021 -
Doubts cast on CPAP efficacy evidence in HHS agency review
A report prepared for the Agency for Healthcare Research and Quality found available studies "mostly" do not support a link between continuous positive airway pressure therapy and long-term, clinically important outcomes.
By Nick Paul Taylor • April 14, 2021 -
Surprise Billing
Patients hit with surprise medical bills paid ER docs 10 times more than others
The findings published in Health Affairs suggest why some ER groups resist coming in-network with insurers: They stand to collect more in revenue if they stay outside a network, posing a financial risk to patients.
By Samantha Liss • April 13, 2021 -
Kaiser Permanente taps chief information technology officer
Diane Comer, who joined the integrated system in 2007, helped deploy the tech systems needed to support the Affordable Care Act and health insurance exchanges.
By Roberto Torres • April 9, 2021 -
Urgent care centers draw some ER visits but associated with higher spending overall
The findings published in Health Affairs may suggest patients are going to the centers instead of more appropriate and lower cost settings like a primary care office or virtual visit.
By Shannon Muchmore • April 7, 2021 -
Brian Thompson named CEO of UnitedHealthcare
The executive, who joined UnitedHealth Group in 2004, was most recently head of UnitedHealthcare's government business, including its Medicare, retirement and community and state divisions.
By Rebecca Pifer Parduhn • April 7, 2021 -
Medtechs top pharma in cash to doctors for consulting, travel: Health Affairs
The study also found payments from medical device companies increased greatly as Medicare billing increased among surgeons.
By Ricky Zipp • April 7, 2021 -
Medtronic inks value-based care pact with Spectrum Health
The risk-based deal, initially focused on cardiac resynchronization therapy, will have the medtech giant paying the provider if certain patient metrics are not met, according to a spokesperson for the health system.
By Nick Paul Taylor • April 1, 2021 -
One-third of small businesses say health insurance is a top concern during COVID-19: survey
The new poll from the Small Business Majority and Families USA also found that pain is particularly acute among Black-, Asian American- and Latino-owned businesses, which tend to have fewer resources than their White counterparts.
By Rebecca Pifer Parduhn • March 31, 2021 -
Payer lobbies cheer new bipartisan bill allowing audio-only telehealth in MA
"Lawmakers have recognized the importance of telehealth, and this important legislation recognizes that for many seniors, a phone call is their only option for health care at home," AHIP CEO Matt Eyles said Wednesday.
By Rebecca Pifer Parduhn • March 25, 2021 -
Reality check: Amazon Care may not be that big of a deal
Currently, the effort is a more direct threat to employer-facing point solutions, instead of the more comprehensive offerings from entrenched vendors.
By Rebecca Pifer Parduhn • March 23, 2021 -
Courtesy of Humana
Humana CFO to depart
Susan Diamond, president of the health insurer's home business, will assume the role of interim CFO on June 1 while Humana completes an external search for Brian Kane's replacement.
By Jane Thier • March 23, 2021 -
E.A. Crunden/Healthcare Dive
House passes bill that would extend Medicare sequester cuts until December
The cuts will go back into effect March 31 and the bill now awaits action from the Senate. The hospital industry has been pushing hard for a delay.
By Hailey Mensik • March 19, 2021 -
Retrieved from C-SPAN on February 24, 2021
Becerra confirmed as HHS secretary
The 50-49 vote in the Senate was almost entirely along party lines. The only Republican to cross the aisle was Sen. Susan Collins of Maine.
By Shannon Muchmore • March 18, 2021 -
Permission granted by Health Affairs
Q&AHealth Affairs' Alan Weil reflects on 1 year of COVID-19
The editor in chief of the respected industry journal spoke with Healthcare Dive about the role of equity in health research, the staying power of telemedicine and how to effectively communicate important public health messages.
By Shannon Muchmore • March 18, 2021 -
Getty Images
CMS puts the brakes on breakthrough device coverage rule
The policy would automatically OK Medicare reimbursement for devices with FDA breakthrough status, but critics contend the rule would undermine CMS authority to consider the clinical evidence backing new technologies.
By Susan Kelly • March 17, 2021 -
Despite pandemic, MedPAC advises few changes to 2022 provider payments
To the extent that the effects of the crisis are temporary and vary significantly depending on provider, they're best addressed through targeted yet temporary funding policies, the congressional advisers said in an annual report.
By Rebecca Pifer Parduhn • March 16, 2021 -
Courtesy of Walmart
CMS hikes COVID-19 vaccine pay, broadens scope of providers to give jab
The AMA praised the boosted reimbursement, intended to speed up distribution of the three currently available shots.
By Shannon Muchmore • March 16, 2021 -
Alex Wong via Getty Images
The top drugs that could be impacted by an obscure provision in the pandemic relief law
Elimination of the so-called penny rule in Medicaid could force drugmakers to pay larger rebates on a number of top medicines, including some HIV, diabetes and anti-inflammatory drugs.
By Jonathan Gardner • March 15, 2021 -
adeline kon/Healthcare Dive, data from Adeline Kon / Healthcare Dive
COVID-19: 1 year later
For the healthcare industry, much has changed, and some of those alterations may be permanent. Hope is beginning to bloom as three coronavirus vaccines have been authorized for emergency use in the U.S.
March 15, 2021 -
Ohio sues Centene, alleging PBM practices led to millions in overpayments
The payer called the claims "unfounded" in a statement, and said it planned to aggressively defend the integrity of its pharmacy services in Ohio.
By Rebecca Pifer Parduhn • March 12, 2021
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