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

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

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

Dozens of Select Medical LTCHs sue HHS over dual-eligible bad debt

The Provider Reimbursement Review Board refused to reimburse plaintiff hospitals' dual eligible bad debts involving 21 state Medicaid programs. 

By Dana Elfin • Aug. 28, 2019

From wellness to well-being: the evolution of employer health initiatives

What started as on-site yoga classes and smoking cessation programs has evolved into something more holistic and wide-reaching.

By Pamela DeLoatch • Aug. 28, 2019

CMS updates Medicare Plan Finder following stakeholder pressure

The first iteration has been criticized by myriad stakeholder groups, including the Government Accountability Office, since its 1998 launch.

By Rebecca Pifer • Aug. 27, 2019

Multiple sclerosis drug costs skyrocketed for Medicare and patients, study finds

Out-of-pocket spending on MS medications increased by more than 600% in the decade from 2006 to 2016, while the typical list price quadrupled.

By Andrew Dunn • Aug. 27, 2019

Humana touts wellness program's impact on productivity, cost savings

Though it's hard to quantify the success of such programs, the payer's researchers concluded organizations should expect to see value after three to five years.

By Lisa Burden • Aug. 27, 2019

Big 5 payers grow MA market share in August

Despite reports Medicare Advantage is failing to produce savings for taxpayers, big insurers continue to snap up market share. CVS had the strongest year-over-year growth, aided by its acquisition of Aetna.

By Rebecca Pifer • Aug. 22, 2019

ACA enrollment could stabilize if premiums stay flat

Critics had feared that Republican efforts to undermine the ACA would lead to large decreases in the number of people enrolled in plans sold in the individual insurance market, though a report shows a small decrease in 2019's Q1.

By Linda Wilson • Aug. 22, 2019

Wyoming seeks to regulate air ambulances like a public utility

Federal regulations have stymied state efforts to regulate air ambulances. Wyoming is trying a new approach, but first it needs CMS on board.

By Samantha Liss • Aug. 21, 2019

Centene, Aetna protest after losing lucrative Louisiana Medicaid contracts

Both insurers called the process bias and tainted. The deals are worth billions.

By Samantha Liss • Aug. 21, 2019

Three California networks see promising results in CMS quality initiative

The program reported savings of $345 million over four years in costs that payers would have otherwise incurred from ER visits, hospital admissions, diagnostic tests and other services.

By Linda Wilson • Aug. 21, 2019

US task force expands recommended BRCA test population

The Preventive Services Task Force's update potentially boosts business for Myriad Genetics and other BRCA test makers. 

By Nick Paul Taylor • Aug. 21, 2019

Obamacare exchange consumers stick around longer. Does that mean they're sicker?

The churn expected within the ACA exchanges did occur, though not as fiercely as expected. Now the tide is shifting.

By Samantha Liss • Aug. 20, 2019

Kidney transplants jump under Medicaid expansion

A study of more than 15,000 adults with advanced kidney disease showed rates rose after the Affordable Care Act's broadening of coverage, allowing patients access to the pricey procedure.

By Samantha Liss • Aug. 20, 2019

Big health plans pledge to look beyond shareholders. Critics aren't so sure

Skeptics call the letter from the Business Roundtable a political stunt in lieu of concrete action. Kaiser Permanente chose not to sign, citing its not-for-profit status.

By Rebecca Pifer • Aug. 19, 2019

CMS to update hospital star ratings early next year despite blowback

"Republishing the flawed ratings in 2020 will not advance the goal of providing the public with accurate, purposeful information about quality," the American Hospital Association's SVP of policy said.

By Rebecca Pifer • Updated Aug. 19, 2019

Amgen biosimilar debut boosted by UnitedHealthcare coverage switch

UnitedHealthcare will preferentially cover lower-cost versions of Roche's top-selling cancer drugs, helping Amgen's efforts to gain market share. 

By Ned Pagliarulo • Aug. 19, 2019