Payer: Page 82
-
$190 or $47,779? Colorado emergency charges vary wildly across state
But the entire cost of care is likely higher, as the Center for Improving Value in Health Care only looked at direct reimbursement from commercial payers.
By Rebecca Pifer • Aug. 19, 2019 -
Medicare Advantage is booming but not producing savings, report finds
At the same time, the Medicare Shared Savings Program is cutting costs, but punitive aspects of the program make it less alluring for providers.
By Samantha Liss • Aug. 19, 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 -
Price, safety will test blockbuster billing for AbbVie's new arthritis drug
Rinvoq adds another oral option to rheumatologists' tool kits at a list price of $59,000 per year.
By Jacob Bell • Aug. 16, 2019 -
CMS brings controversial star ratings system to ACA plans
Insurance lobby AHIP is not opposed to the rankings, telling Healthcare Dive they're a "positive step" for plan shopping.
By Samantha Liss • Aug. 16, 2019 -
Nation's uninsured rose 700K in Trump's first year
States that refused to expand income eligibility for Medicaid saw the highest increase in uninsured rates.
By Ron Shinkman • Aug. 16, 2019 -
Tufts, Harvard Pilgrim say they intend to merge
The yet-to-be-named combined nonprofit payer will serve 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island.
By Linda Wilson • Aug. 15, 2019 -
Hospitals facing likely DSH payment cuts after appeals court ruling
A federal appeals court reinstated a 2017 rule allowing Medicare and private insurance payments to be included in how Disproportionate Share Hospital reimbursements are calculated.
By Dana Elfin • Aug. 15, 2019 -
Tweaking CMS model variables can improve payment estimates, JAMA study finds
Researchers looked at how to improve predictions for three conditions: acute myocardial infarction, heart failure and pneumonia.
By Dana Elfin • Aug. 14, 2019 -
UnitedHealth Group report targets rising hospital prices
The insurer said inpatient prices rose 4.5% annually from 2013 through 2017 — even though consumers' use of inpatient care dropped 5%.
By Linda Wilson • Aug. 14, 2019 -
Centene expands ACA offerings in 10 states
About 2 million people have health insurance coverage through the insurer's exchange products. The expansion in 10 markets will likely boost that figure.
By Samantha Liss • Aug. 14, 2019 -
Average marketplace premiums for 2020 show smallest increase ever
Rates are expected to rise very modestly for those shopping for individual coverage. Colorado will actually see a decrease in average premiums, according to a report from Charles Gaba of ACASignups.net.
By Samantha Liss • Aug. 13, 2019 -
ACA market continues to lose those who don't qualify for financial help
Six states lost 50% or more of their unsubsidized population, or people who don't qualify for financial help. Iowa lost 85% of such customers.
By Samantha Liss • Aug. 13, 2019 -
Large employers look to virtual care to tackle high-cost claims in 2020, survey finds
The total cost of health benefits is expected to increase by 5% in 2020, in line with 2019. Of the 147 companies polled, 85% said expensive drugs were a top pharmacy-related concern.
By Dana Elfin • Aug. 13, 2019 -
Rite Aid names new CEO
Heyward Donigan is a seasoned healthcare executive, suggesting that the drugstore will join rivals in emphasizing medical services over retail.
By Daphne Howland • Aug. 13, 2019 -
Surprise bills surge in ER, inpatient settings, JAMA finds
The study comes as lawmakers prepare to debate legislation tackling the problem, including a Senate bill that sets a payment standard for out-of-network services. Providers are pushing back.
By Shannon Muchmore • Aug. 12, 2019 -
Kaiser Permanente net income soars to $2B
The integrated health system said the first half of the year typically delivers stronger results due to open enrollment.
By Samantha Liss • Aug. 12, 2019 -
Lack of tech, not jobs, could ding Medicaid enrollees facing work requirements
A large proportion of enrollees in the 16 states attempting to impose work requirements on Medicaid beneficiaries already have jobs or are providing care for someone in their household, according to the Kaiser Family Foundation.
By Ron Shinkman • Aug. 12, 2019 -
North Carolina folds to provider pressure with insurance plan shifting away from set rates
The new hybrid network will consist of more than 68,000 providers. The initial proposed State Health Plan network included only 28,000.
By Rebecca Pifer • Aug. 9, 2019 -
Louisiana drops Aetna, Centene plans from 2020 Medicaid managed care contracts
The state public health department dropped the two vendors, which manage benefits for roughly a third of the state’s 1.7 million Medicaid enrollees.
By Ron Shinkman • Aug. 9, 2019 -
Courtesy of Gilead Sciences
Medicare boosts CAR-T cancer therapies with expanded coverage
CMS also broadened the settings in which the pricey therapies would be covered, applying its final rule to use in "healthcare facilities" rather than explicitly in hospitals.
By Ned Pagliarulo • Aug. 8, 2019 -
California surprise billing law disrupted contract negotiations, stakeholders say
The 2017 law was also perceived to have driven further provider consolidation in response to the leverage shift, according to research published in The American Journal of Managed Care.
By Shannon Muchmore • Aug. 7, 2019 -
Few patients price shop before planned hospital visit, survey finds
As CMS and lawmakers push for price transparency, the survey from a revenue cycle management software vendor suggests consumers may not know how to evaluate different options based on price, or even be aware that prices vary.
By Linda Wilson • Aug. 7, 2019 -
CVS handily beats estimates, hikes 2019 forecast
The tailwinds helping the chain in the first quarter kept blowing in the second, generating revenue of $63.4 billion largely due to the Aetna acquisition.
By Rebecca Pifer • Aug. 7, 2019 -
Adeline Kon/Healthcare Dive
ColumnMyth Diagnosis: Do hospitals charge more to make up for low government pay?
"What is crystal clear is that there's a huge unit cost payment differential between government and commercial payers," John Pickering of Milliman said. "What isn't clear is whether there's a causal effect between those two."
By Shannon Muchmore • Aug. 7, 2019 -
Medicare Advantage market financially robust, attractive to insurers, report finds
Premium hikes coupled with slow claims growth made 2018 the most profitable year for individual market payers since the Affordable Care Act became effective, according to the Kaiser Family Foundation.
By Dana Elfin • Aug. 7, 2019
Previous
