Payer: Page 83
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CVS expands at-home drug delivery program nationwide
The paid membership program is notably similar to Amazon's Prime membership as the two retail giants compete in emerging healthcare markets.
By Daphne Howland • Aug. 5, 2019 -
CMS tweaks hospital wage index change in final rule
The agency is heeding some concerns from hospital groups that facilities in urban areas would be unfairly dinged in the original plan, but the American Hospital Association isn't entirely on board with the new method either.
By Shannon Muchmore • Aug. 2, 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 -
Anthem again irks docs with latest changes to reimbursement
"It is a nuisance. It makes absolutely no sense," dermatologist George Hruza said of the policy denying payment for certain follow-up office visits the same day a procedure is performed.
By Samantha Liss • Aug. 2, 2019 -
Cigna Q2 boosted by Express Scripts rebound
The payer nearly tripled its revenue in the second quarter and upped its guidance for the full year thanks to its pharmacy business.
By Samantha Liss • Aug. 1, 2019 -
Molina beats Q2 expectations despite drops in income, revenue
The insurer raised its guidance for the full year, suggesting it "isn't experiencing the challenges some MCOs have mentioned" in earlier reports for the second quarter, analysts at Jefferies said.
By Shannon Muchmore • July 31, 2019 -
White House backs importing drugs from abroad
The Trump administration's latest drug price plan features ideas Republicans traditionally oppose, and breaks with past claims about the FDA's ability to safely oversee importation.
By Jonathan Gardner • July 31, 2019 -
Humana sees biggest MA growth in a decade, steels for 2020 tax impact
Second quarter results beat analyst earnings and revenue estimates. The payer said it will invest some gains to offset pressure coming next year.
By Samantha Liss • July 31, 2019 -
Problems with Medicare Plan Finder to spur CMS revamp
The tool contains complex terminology the average layperson is unlikely to understand and makes consumers navigate through multiple pages before accessing plan details, according to a new government watchdog report.
By Rebecca Pifer • July 31, 2019 -
Humana accuses Abbott of duping it to pay to remove dodgy heart devices
The suit alleges St. Jude, now a part of Abbott, knew about a defect in its heart rhythm devices for four years before notifying FDA and then schemed to have the insurer pay for surgeries to remove patients' implants.
By Susan Kelly • July 30, 2019 -
Judge nixes New Hampshire's Medicaid work requirement
The ruling is the third time the judge has shot down such demonstration projects, having vacated similar plans in Arkansas and Kentucky on identical grounds.
By Dana Elfin • July 30, 2019 -
CMS proposes forcing hospitals to reveal negotiated rates
Insurer and hospital groups swiftly pushed back against a mandate to publish payer-specific rates for at least 300 services that patients can plan in advance. A legal challenge is likely.
By Samantha Liss • July 30, 2019 -
Sponsored by HMS
COB innovation: Identifying Medicaid 3rd party liability prior to the point of care
Improperly declaring Medicaid as the primary payer when other coverage exists is a seemingly small error that has widespread implications for the healthcare ecosystem.
July 30, 2019 -
CMS will no longer approve full federal funding for partial Medicaid expansion
The policy pivot dashes the hopes of a handful of Republican states looking to receive more federal money for covering fewer people than states with full Medicaid expansion under the Affordable Care Act.
By Rebecca Pifer • July 29, 2019 -
Senate advances drug pricing bill, setting up September vote
PhRMA's CEO, along with a number of drugmaker executives, met with President Trump this week to lay out their opposition to the bill.
By Jonathan Gardner • July 26, 2019 -
OIG suggests closer look at impact of rule pushing risk on Medicare ACOs
In another recommendation on the Medicare Shared Savings Program, the watchdog suggested CMS adopt outcomes-based performance measures — rather than process measures — and standardize measures across programs.
By Linda Wilson • July 25, 2019 -
Private equity gobbles up dermatology practices, raising questions about outcomes, costs
An analysis in JAMA Dermatology attempts to illustrate the growth of such PE-backed acquisitions and the spread geographically over time.
By Samantha Liss • July 24, 2019 -
Medicaid coverage cuts mortality rates among low-income adults aged 55 to 64
A National Bureau of Economic Research study of "near-elderly" low-income adults showed Medicaid expansion reduced mortality rates, but future Medicaid expansion is in limbo as the Affordable Care Act is challenged in court.
By Linda Wilson • July 24, 2019 -
As HHS muses more MA flexibility, payers see roadblocks to nonmedical benefits
Implementation challenges, uncertain return on investment and a lack of clarity on what supplemental benefits are allowed are making some payers wary of offering nonmedical services in Medicare Advantage.
By Rebecca Pifer • July 24, 2019 -
Anthem blames Medicaid for medical cost bump in Q2
The payer is not alone in reporting an increase in its medical cost ratio for the second quarter, joining its peers Centene and UnitedHealthcare.
By Samantha Liss • July 24, 2019 -
Even $10 increase in Medicaid payments helps erase disparities in care access, study says
Financial incentives influence who a physician decides to treat and their patients' overall health, the National Bureau of Economic Research found.
By Samantha Liss • July 23, 2019 -
Senate committee targets Medicare drug price increases with bipartisan bill
Legislation proposed Tuesday would also reimburse physicians less for administering expensive intravenous drugs to beneficiaries.
By Jonathan Gardner • July 23, 2019 -
CMS' Verma blasts 'Medicare for All,' public option in rhetoric ramp up
The remarks were unusually strong for the CMS leader. Though she has often beat the party drum on plans conservatives call a dangerous step toward socialism, the breadth and specifics of her critique expanded.
By Rebecca Pifer • July 23, 2019 -
CVS to test knee replacement program for Aetna beneficiaries
The pilot is the first of a series of broad initiatives the merged health giant is working on, CVS CEO Larry Merlo announced Tuesday at a Medicare Advantage conference.
By Rebecca Pifer • July 23, 2019 -
ACA, other coverage expansions not linked with rising hospital use, study shows
Researchers looked at hospital use after introduction of Medicare and Medicaid and after the ACA and concluded universal coverage "is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained."
By Shannon Muchmore • July 23, 2019 -
As ACA exchange members stay longer, Centene sees medical cost bump in Q2
CEO Michael Neidorff clashed with analysts seeking more specificity on margins on an investor call.
By Samantha Liss • July 23, 2019
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