Payer: Page 80
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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 -
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 -
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 -
7 can't-miss panels at HLTH19
Some of healthcare's biggest names are converging in Las Vegas in just a few days for the second annual HLTH conference. We've combed through the dozens of panels so you don't have to.
By Rebecca Pifer • Oct. 24, 2019 -
1/3 of US payments used alternative models last year, but progress stagnant
Medicare Advantage plans had the highest percentage of total payments tied to APMs, followed by traditional Medicare, commercial payers and Medicaid, a study from a private-public partnership found.
By Linda Wilson • Oct. 24, 2019 -
Anthem's Q3 revenue, income up as PBM launch moves forward
The payer's medical loss ratio, however, was up — hitting 87.2% for the third quarter this year from 84.8% last year and slightly above analyst predictions.
By Shannon Muchmore • Oct. 23, 2019 -
Deep Dive
5 insights from a chat with Larry Merlo, CEO of CVS Health
Healthcare Dive talked to Merlo, who rose up the ranks to lead the giant chain over three decades, about CVS' rivals, the path to the Aetna acquisition and potential arenas for disruption.
By Rebecca Pifer • Oct. 23, 2019 -
Verma dodges on backup plan if ACA is struck down
Democrats accused the CMS administrator of stonewalling in her testimony in front of a House committee Wednesday, with a federal appeals court ruling on the fate of the landmark law expected any day.
By Rebecca Pifer • Oct. 23, 2019 -
Trump admin touts dip in ACA exchange plan premiums
On average, those shopping for plans on the exchange will have more options at a lower price, CMS Administrator Seema Verma said Monday on a call with reporters.
By Samantha Liss • Oct. 22, 2019 -
Medicaid boosts Centene Q3, but medical loss ratio up
The payer also said its $17 billion acquisition of WellCare may close sooner than expected.
By Samantha Liss • Oct. 22, 2019 -
Humana, Microsoft ink 7-year deal for cloud services
The payer, which already partners with telehealth vendor Doctor on Demand for virtual primary care visits, will also develop similar tools with Microsoft.
By Rebecca Pifer • Oct. 21, 2019 -
'Medicare for All' likely to keep private payers, but erode margins: Moody's
Several recent reports game out the costs and benefits of Democratic 2020 presidential hopefuls' healthcare proposals.
By Ron Shinkman • Oct. 18, 2019 -
Key committee pitches adding UDIs to insurance claim forms, called 'huge step'
If a unique device identifier is captured when a high-risk product is implanted, providers will be able to detect complications more quickly, said Joe Drozda, the director of outcomes research at Mercy Health.
By David Lim • Oct. 16, 2019 -
Overwhelming majority of providers loathe prior authorization requirements, survey shows
HHS is attempting to address the issue, proposing a rule in June to update electronic prior authorization requirements in Medicare Part D plans. The head of ONC has also called for an overhaul of the process.
By Shannon Muchmore • Oct. 16, 2019 -
UnitedHealth boasts $60B revenue in Q3, buoyed by Optum
The massive healthcare company kicked off managed care organizations' earnings season Tuesday by handily beating Wall Street expectations.
By Rebecca Pifer • Oct. 15, 2019 -
Oscar files appeal in battle with Florida Blue over exclusive broker policies
A federal judge ruled against the startup last month, despite the U.S. Department of Justice arguing the case should not be tossed.
By Samantha Liss • Oct. 15, 2019 -
CMS issues 2020 star ratings for Medicare Advantage plans; Kaiser dominates
Centene and WellCare did not fare so well as the two attempt to wrap up their merger, a finding one analyst called "less-than-inspiring."
By Ron Shinkman • Oct. 14, 2019 -
As Medicaid work requirements cost taxpayers $408M, government watchdog calls for more oversight
"More money, fewer people with care. And you paid for 87% of it!" Andy Slavitt, who headed up CMS under former President Barack Obama, tweeted of the administrative costs associated with Medicaid work requirements.
By Samantha Liss • Oct. 11, 2019 -
UnitedHealth doubles down on telemedicine with app in employer-sponsored plans
The insurer currently contracts with Teladoc, American Well and Doctor on Demand to offer virtual visits, though it is in talks to partner with local providers.
By Rebecca Pifer • Oct. 10, 2019 -
For COPD patients with high deductibles, more trouble getting care
Authors of the study said plans that "raise out-of-pocket costs or give individuals more 'skin in the game' could harm patients."
By Shannon Muchmore • Oct. 10, 2019 -
Fresenius to pay $5.2M to settle Medicare overbilling allegations
DOJ alleged the company overbilled Medicare for more than seven years by ordering hepatitis B tests for patients it knew to be immune to the virus.
By Nick Paul Taylor • Oct. 10, 2019 -
Elizabeth Regan/Healthcare Dive
With new report, ICER puts itself at center of drug pricing storm
Pharma price hikes added billions of dollars to U.S. spending in 2017 and 2018. For seven top drugs, the watchdog found those increases came with little new clinical evidence in support.
By Ned Pagliarulo • Updated Oct. 8, 2019 -
Colorado's public option plan cuts provider rates to lower premiums
The state hospital association immediately slammed the proposal as akin to government rate-setting with "the potential to significantly damage the health insurance market in our state."
By Rebecca Pifer • Oct. 9, 2019 -
Former FDA chief Gottlieb predicts Trump-pitched pricing model easy to game
"I don't want to give too much away, because I'll tell people how to game around this," said the former commissioner, who now sits on Pfizer's board of directors.
By Andrew Dunn • Oct. 9, 2019 -
Sponsored by Geneia LLC
How to use AI to reduce diabetes costs
Using AI to predict which type 2 diabetics will experience a diabetes-related complication can help payers save millions of dollars.
By Jasmine McCammon, Ph.D., Geneia Principal Data Scientist • Oct. 9, 2019
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