Court refuses to stay or reconsider decision tossing CMS site neutral rule

The court on Monday refused to modify its earlier opinion, meaning HHS will have to work out remedies for payments withheld due to the final rule.

By Dana Elfin • Updated Oct. 21, 2019

Hospital market concentration on the rise, along with prices

The Health Care Cost Institute found metro areas most concentrated also had steeper increases in inpatient prices and vice-versa​. The AHA pushed back.

By Shannon Muchmore • Sept. 17, 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

Congress probes private equity firms financing surprise billing fight

Responses from KKR, Blackstone Group and Welsh, Carson, Anderson & Stowe are due no later than Sept. 30. 

By Samantha Liss • Sept. 17, 2019

Dueling reports highlight payer, provider finger-pointing over healthcare costs

Three-quarters of metro areas had a highly concentrated commercial health insurance market in 2018, up from 71% in 2014, according to the study.

By Shannon Muchmore • Sept. 17, 2019

Health system president calls out BCBS of Massachusetts amid reimbursement squabble

Southcoast Health is looking to sign a new contract with BCBSMA to remain in-network. In a recent letter to the editor of a local newspaper, Southcoast President Keith Hovan said the payer is putting "revenues before our patients."

By Samantha Liss • Sept. 17, 2019

Treatment centers sue UnitedHealth unit for $5M in denied claims

The action comes on the heels of a court ruling from early this year that found United Behavioral Health's treatment guidelines were too restrictive, leading to care being denied for substance use disorders.

By Samantha Liss • Sept. 16, 2019

American Kidney Fund lobbies White House on charitable premium assistance

Insurers are pushing for a reexamination of policies they argue allow financially interested third parties to steer end-stage renal disease patients eligible for Medicare or Medicaid to private plans.

By David Lim • Sept. 16, 2019

Most nations grappling with increased healthcare cost trends

The world's most expensive healthcare is in the United States. However, other countries are also struggling with medical costs and inflation.

By Ron Shinkman • Sept. 13, 2019

Nursing home operator gets 20-year sentence in $1B healthcare fraud case

The government used advanced data analysis and forensic accounting to uncover the full scope of the Miami-area scheme that bilked Medicare and Medicaid.

By Dana Elfin • Sept. 13, 2019

Colorado union votes to strike at Kaiser, bringing 'yes' votes nationwide to 42K

The strike is scheduled to begin Oct. 14 and run for seven days.

By Rebecca Pifer • Updated Sept. 17, 2019

In blow to Amazon's PillPack, Surescripts terminates contract with data startup

The move is the latest in ongoing tensions between the e-commerce giant and CVS, which, along with pharmacy benefit manager Express Scripts and two trade groups, owns Surescripts.

By Shannon Muchmore • Sept. 12, 2019

Employers urged to get off sidelines to trim healthcare costs

"Healthcare is not their day job. They build ships. They stock groceries," the CEO of the Pacific Business Group on Health said. "But as costs go up, they're the ones paying it."

By Rebecca Pifer • Sept. 11, 2019

Without much choice on ACA exchanges, will star ratings matter?

The plan rankings are coming Nov. 1, but large swaths of the country have few carriers to choose from, raising questions about the usefulness of a rankings system.

By Samantha Liss • Sept. 11, 2019

Insurers to deliver whopping $1.3B in ACA consumer rebates

The record amount revealed in a Kaiser Family Foundation analysis reflects how profitable payers were over the past few years, largely fueled by plans in the individual market.

By Samantha Liss • Sept. 11, 2019

Back in session, Congress faces industry pushback on surprise billing

Intense lobbying by industry has taken its toll on the potential for a fix, once viewed as a promising field of action with bipartisan backing and even mention from President Donald Trump.

By Shannon Muchmore • Sept. 10, 2019

Uninsured rate rises for 1st time since ACA

The percentage of people with public coverage fell by 0.4 percentage points between 2017 and 2018 while the percentage of Americans with private coverage did not change, according to the the U.S. Census Bureau.

By Rebecca Pifer • Sept. 10, 2019

UnitedHealth to link Optum's analytics, provider subsidiaries

Patients and providers will be able to access health data in real time as part of this new "digital ecosystem," Optum CEO Andrew Witty said Thursday.

By Rebecca Pifer • Sept. 5, 2019

Imaging test usage is re-accelerating, JAMA study finds

Neither financial incentives nor a campaign to reduce the use of medical imaging have been completely effective, research suggests.

By Susan Kelly • Sept. 4, 2019

Citing transparency, PBM startup Capital Rx introduces novel pricing model

The framework announced Wednesday, called Clearinghouse Model, is aimed at eliminating price variability for the PBM's customers by itemizing the actual unit cost for all drugs based on a CMS-run benchmark.

By Rebecca Pifer • Sept. 4, 2019

Policies reducing price variations may produce savings, study suggests

Payers in Massachusetts could have saved a significant amount of money by steering patients to low-cost providers or setting a price ceiling, according to the research in Health Affairs.

By Linda Wilson • Sept. 4, 2019

Nebraska advocacy group sues to speed state's planned Medicaid expansion

The suit, filed by the group Nebraska Appleseed, calls for expansion to begin no later than Nov. 17.

By Ron Shinkman • Aug. 30, 2019

Medicare paying hospices twice for drugs, OIG says

CMS should develop an oversight program with controls to identify and stop duplicate payments, the inspector general said.

By Linda Wilson • Aug. 29, 2019

Unblinded: Rebekah Gee's drug pricing experiment

Louisiana's health secretary negotiated a new payment model with Gilead for one of the poorest states in the country. Could it spread nationwide?

By Andrew Dunn • Aug. 28, 2019

After airing complaints, Kansas Hospital Association optimistic Aetna can fix Medicaid woes

Aetna is in the hot seat over its Medicaid contract in Kansas. Providers have sounded the alarm about the payer's less-than-stellar coverage, causing the state to issue a corrective action plan.

By Samantha Liss • Aug. 28, 2019

Pharmacogenetic test makers cheer UnitedHealth coverage. Other payers aren't there yet

"I've been concerned that the hype around pharmacogenetics, at least for depression, has gotten out ahead of the data," James Potash, director of psychiatry at Johns Hopkins University, said.

By Graison Dangor • Aug. 28, 2019