The value-based care crossroad: How health plans can remain on course

Why are providers finding the transition from traditional fee-for-service to newer value-based care models to be such a bumpy road?

Nov. 14, 2019

Providers shell out $2.76B annually to update directories

Medical practices spend nearly $1,000 per month updating lists of insurers' in-network providers, according to a new report from an alliance of big payers.

By Linda Wilson • Nov. 14, 2019

Explore the Trendline➔

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

ICER draws new gene therapy pricing framework

One-time and short-term curative therapies require a different approach to evaluating benefit, the cost watchdog group said. 

By Jonathan Gardner • Nov. 13, 2019

CMS pitches ramped up oversight of Medicaid payments, promises block grant guidance

Provider lobbies clapped back Wednesday against the proposed rule, with America's Essential Hospitals calling it a "deeply damaging" policy that would erode state flexibility and the medical safety net.

By Rebecca Pifer • Updated Nov. 13, 2019

Kaiser Permanente net income tops $1B, margins sag

Unions have cited the not-for-profit's hefty income to push for better working conditions. CFO Kathy Lancaster defended the profits, which she said "allows us to make investments in technology, infrastructure, and our people."

By Linda Wilson • Nov. 12, 2019

Surprise billing services had higher-than-average markups

Annual price bumps were greatest at for-profit hospitals, those that served more uninsured patients (for emergency medicine services) and facilities in the Southeast, according to a research letter in JAMA Internal Medicine.​

By Shannon Muchmore • Nov. 11, 2019

From telehealth to 'Medicare for All': takeaways from HLTH19

All of Healthcare Dive's coverage from the health innovation conference's second year.

Nov. 8, 2019

Behind insurer strategies to snag higher MA star ratings

Last year, more than $6 billion in bonuses were awarded to various types of Medicare Advantage plans. Payers like Cigna and Kaiser say they don't teach to the test, but they do value the rankings.

By Samantha Liss • Nov. 7, 2019

Hospital M&A spurs rising healthcare costs, MedPAC finds

Adding to a growing body of evidence, the Medicare Payment Advisory Commission found providers with greater market share see higher commercial profit margins, leading to higher costs per discharge.

By Rebecca Pifer • Nov. 7, 2019

Retail makes its case, telehealth and voice tech dominate: 6 takeaways from HLTH19

Consumerism has its limits, interoperability rules face execution challenges and more from Las Vegas.

By Rebecca Pifer • Nov. 6, 2019

Humana trims costs, workforce as it readies for health insurance fee

The payer's third quarter results exceeded management's expectations. The company raised its guidance for the full year, fueled by growth in its Medicare Advantage segment.

By Samantha Liss • Nov. 6, 2019

CVS profit up 10% thanks to Aetna; warns Q4 won't be as rosy

The company beat Wall Street earnings and revenue estimates in the third quarter, causing it to raise its full-year guidance and sending its stock up almost 5% Wednesday morning.

By Rebecca Pifer • Nov. 6, 2019

Consumers more likely to leave ACA after their insurer exits

A Health Affairs study also found that shoppers not qualifying for federal premium subsidies were twice as likely to leave when their payer did.

By Linda Wilson • Nov. 6, 2019

Centene, UnitedHealth big winners in $10B Texas Medicaid contracts

Meanwhile, medical cost ratios continued to pose challenges for many payers during the third quarter, according to recent earnings reports.

By Samantha Liss • Nov. 5, 2019

Haven partners with traditional payers in plans offered to Amazon, JPM workers

The nonprofit formed early last year to tackle rising employee healthcare costs spooked established players but has since given few details about how it might accomplish its goals.

By Rebecca Pifer • Nov. 5, 2019

Execs flirt with 'Medicare for All' at HLTH19, despite Trump admin warnings

"Until we see a better idea, it's actually not a bad framework to have a debate around," said the CEO of Medicare Advantage startup Clover Health.

By Rebecca Pifer • Nov. 4, 2019

Litigation prompts Indiana to drop Medicaid work requirement for now

State officials had said the regulation might reduce its Medicaid rolls by about 5%, or 70,000 out of a total enrollment of 1.4 million.

By Ron Shinkman • Nov. 1, 2019

Georgia governor seeks to overhaul ACA market

Gov. Brian Kemp's proposal would push customers away from Healthcare.gov and steer them to sign up for coverage using online portals run by brokers.

By Ron Shinkman • Nov. 1, 2019

Cigna ups guidance after Q3 beat, boosted by Express Scripts

The payer generated adjusted revenue of $35.8 billion for the quarter, more than three times from a year earlier, thanks to the $67 billion acquisition of the pharmacy benefit manager completed in December.

By Samantha Liss • Oct. 31, 2019

CMMI head predicts industry will be 'very happy' with his replacement

"I worked very closely with the administration to identify somebody that has extremely similar values, that's concentrated on doing the right thing," Adam Boehler said Tuesday at the HLTH conference in Las Vegas.

By Rebecca Pifer • Oct. 30, 2019

Molina 'disappointed' by $1B Texas contract loss, weighs protest

Total revenue and net income slipped during the third quarter compared with the prior year, but was in line with the insurer's expectations.

By Samantha Liss • Oct. 30, 2019

Kaiser Permanente rolls out food insecurity initiative in California

"Healthcare across the ecosystem of health plays a very small but important part" in outcomes, Kaiser CEO Bernard Tyson said Monday at HLTH. "Things like behavior, genetics and where you live has a bigger impact."

By Rebecca Pifer • Oct. 29, 2019

HHS chief keeps focus on alternative payment models

Alex Azar on Tuesday hinted at further pushes from CMS on value-based care, including population health benefits like those newly allowed in Medicare Advantage and flat monthly payments for a patient's total cost of care.

By Shannon Muchmore • Oct. 29, 2019

CMS chief Verma teases more Medicaid deregulation

Speaking at the HLTH conference Sunday, Verma also said that as long as states continue to approach CMS with requests for Medicaid work requirements, the agency would approve them.

By Rebecca Pifer • Oct. 28, 2019

US ordered to cough up $1.59B in subsidies to Kaiser, Oscar, other payers

Among the largest creditors in the case are Kaiser Foundation Health Plan, which is owed more than $220 million in cost-sharing reduction subsidies, and Blue Shield of California, with more than $132 million outstanding.

By Dana Elfin • Oct. 25, 2019