Medicare claims data for COVID-19 highlights stark racial, economic disparities

Fee-for-service payments for related hospitalizations totaled $1.9 billion for the first months of the pandemic, with Black Americans four times more likely to end up in the hospital from the coronavirus.

By Shannon Muchmore • June 23, 2020

Virtual care at a virtual conference: Telehealth will remain post-pandemic, experts say at AHIP

"If I were trying to be controversial, of course I'd say, 'No, it's going to go away.' But of course no one believes that," Google Health CMO Karen DeSalvo said. 

By Rebecca Pifer • June 19, 2020

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Payer/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

Medicaid insurers a growing competitive force in ACA marketplaces, report finds

Previous concerns about the managed care organizations' networks, pricing and impact on other insurers' participation have largely dissipated, according to the report from the Urban Institute and Robert Wood Johnson Foundation.

By Hailey Mensik • June 18, 2020

With new proposal, Trump administration tries to encourage 'value-based' drug deals

With an eye toward a coming wave of pricey gene therapies, CMS is seeking to make it easier for drugmakers and insurers to enter into contracts linking payment with patient outcomes.

By Ned Pagliarulo • June 18, 2020

Myriad prostate cancer test wins coverage from Aetna, other insurers

The decisions nearly double commercial coverage for the Prolaris test, days after a local Medicare contractor found there may be insufficient data to back Myriad's GeneSight combinatorial tests.

By Susan Kelly • June 17, 2020

COVID-19 crisis highlights health plans' increased need for expanded analytics and insights

Five ways analytics help solve some payer challenges brought on by COVID-19.

By Molly Gallaher Boddy, Geneia Strategy Planning Manager • June 17, 2020

MedPAC urges MA, ACO tweaks to speed up value-based payment reform

Medicare Advantage and ACOs could be vehicles for much needed value-based payment reform, but not without better aligned incentives and improved quality assessment, the advisory commission said.

By Shannon Muchmore • June 16, 2020

Hit with surprise COVID-19 test bill, lawmaker pushes Trump admin for guardrails to hold patients harmless

Insurers are generally required to cover the tests without cost-sharing under coronavirus relief legislation, yet patients across the country are still receiving bills, Katie Porter, D-Calif., said in a letter to key health officials.

By Rebecca Pifer • June 15, 2020

FCC surpasses $100M in CARES telehealth funding approvals as House seeks more oversight

Top leadership in the House Energy and Commerce committee sent a letter Friday to the FCC requesting more transparency in the telehealth program, which passed the halfway mark in allocated funds earlier this week.

By Rebecca Pifer • Updated June 12, 2020

COVID-19 fuels major unknowns as insurers tackle 2021 rate setting

An American Academy of Actuaries brief laid out challenges that may boost costs, including a shift in coverage leading to adverse selection, deteriorating health for those delaying care and pressure on reimbursement rates.

By Samantha Liss • June 11, 2020

COVID-19 testing costs may hit $25B per year, AHIP study finds

The low estimate for diagnostic testing is $6 billion, while antibody testing costs could range from $5.2 billion to $19.1 billion, according to the report paid for by the payer trade group.

By Shannon Muchmore • June 10, 2020

After fallout with UnitedHealthcare came COVID-19. Now Mednax is rethinking its strategy.

The company will continue to sell off other business units to achieve its singular focus on services for women and children and will change the company name to Pediatrix Medical Group to reflect the new direction.

By Samantha Liss • June 9, 2020

Centene to acquire NextLevel members after closure

Centene controls the largest Medicaid market share in Illinois and the transfer will only boost its enrollment. The deal is expected to close in July.

By Samantha Liss • Updated June 30, 2020

BCBS plans account for nearly half of ACA enrollment, but face rising competition from Medicaid insurers

Medicaid insurers' market share on the exchanges overall ballooned from 15% of the marketplace in 2016 to 27% by 2018.

By Hailey Mensik • June 3, 2020

CMS relaxing more value-based model requirements in wake of pandemic

The changes are aimed at minimizing reporting burden and increasing flexibilities for providers as they continue to face great financial and logistical challenges from the novel coronavirus.

By Shannon Muchmore • June 3, 2020

UPMC latest hospital system to report Q1 loss due to COVID-19

The Pennsylvania-based system's health insurance plan saw increased revenue due to a significant rise in its membership, but its operating income dropped by 56%.

By Ron Shinkman • June 1, 2020

Citing lack of funding, Oklahoma withdraws planned July 1 Medicaid expansion

Millions of Americans have likely been booted off their employer-sponsored insurance and many are newly eligible for Medicaid, something the state didn't anticipate when prepping for the expansion, Republican Gov. Kevin Stitt said.

By Rebecca Pifer • June 1, 2020

Molina, Centene big winners in Kentucky Medicaid award

The lucrative contracts begin next year and cover 1.4 million people with an annual spend of $8 billion.

By Samantha Liss • June 1, 2020

Pathologists most frequent surprise billing offenders, HCCI finds

More than a third of pathologists who billed for inpatient visits did so on an out-of-network basis more than 90% of the time in 2017, according to the Health Care Cost Institute.

By Rebecca Pifer • May 28, 2020

Medicare members using telehealth grew 120 times in early weeks of COVID-19 as regulations eased

CMS head Seema Verma said her department is evaluating the telehealth waivers to determine if they should be extended past the scope of the national emergency, and is in the process of additional rulemaking around the issue.

By Rebecca Pifer • May 27, 2020

COVID-19 has forced nearly half of patients to postpone care

About a third of those who have put off treatment said they would seek it in the next three months, and 10% said they will do so in four months to a year, according to a new survey from the Kaiser Family Foundation.

By Shannon Muchmore • May 27, 2020

Employee wellness programs unlikely to move the needle on health, study finds

Participants said they believed they were healthier and were also more likely to have a primary care physician. However, there was no data showing their health had improved, the new study in JAMA Internal Medicine found.

By Ron Shinkman • May 27, 2020

Over 1,750 Part D, MA plans applied for new CMS insulin model

Payers cheered the effort to lower insulin costs and drugmakers Eli Lilly, Novo Nordisk and Sanofi have said they plan to participate. But powerful lobby PhRMA pushed back against the model.

By Rebecca Pifer • May 26, 2020

MA, Part D final rule gives more star ratings weight to patient experience

The rule also attempts to let more MA plans comply with network adequacy standards by reducing the percentage of rural beneficiaries that must reside within maximum time and distance areas.

By Shannon Muchmore • May 22, 2020

Labs welcome CMS rate for coronavirus antibody testing

Analysts at William Blair said the roughly $42 rate for common serological tests is higher than expected, which may bode well for antigen testing reimbursement.

By Nick Paul Taylor • May 20, 2020