Payer: Page 83
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LabCorp, Quest push for M&A-driven growth despite difficulties closing deals
"It’s still a very fragmented marketplace. There’s plenty of opportunity for us to consolidate it," Quest CEO Steve Rusckowski said.
By Nick Paul Taylor • Jan. 15, 2020 -
Deep Dive
Will more employers get off the healthcare bench in 2020?
"At the end of the day, employers have to put their hands on the steering wheel as purchasers of healthcare," Suzanne Delbanco, executive director of Catalyst for Payment Reform, said.
By Rebecca Pifer Parduhn • Jan. 14, 2020 -
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 -
Cigna links up with upstart Oscar for small business health insurance
New York City-based Oscar has won some praise for customer service, but also criticism for small provider networks.
By Rebecca Pifer Parduhn • Jan. 14, 2020 -
JPM20: Rivals Molina, Centene pitch investors on organic growth
"I'll repeat this countless numbers of times this afternoon: Our first priority is to grow the business organically. It is the most efficient use of capital," Molina CEO Joseph Zubretsky said as the annual investor conference kicked off.
By Samantha Liss • Jan. 14, 2020 -
Supreme Court to take on PBM rate regulation
A federal appeals court previously ruled in favor of pharmacy benefit managers, finding federal law preempts states from regulating their rates.
By Samantha Liss • Jan. 13, 2020 -
The government recovered $3B in fraud last year. Nearly 90% was from healthcare
It marks the 10th consecutive year the DOJ has recouped more than $2 billion from False Claims Act settlements and judgments for HHS.
By Rebecca Pifer Parduhn • Jan. 10, 2020 -
CVS, Mayo, Tenet among healthcare companies to watch at #JPM20
As many as 9,000 attendees across 450 public and private companies are expected to make an appearance in San Francisco at one of the most influential conferences of the year.
By Samantha Liss , Shannon Muchmore , Rebecca Pifer Parduhn • Jan. 10, 2020 -
Individual market appears stable despite lack of mandate penalty
Claims costs in the first nine months of 2019 grew and average hospital time dipped, indicating the market didn't have disproportionately sicker patients, according to the Kaiser Family Foundation.
By Shannon Muchmore • Jan. 8, 2020 -
Molina expands Illinois footprint with $50M acquisition
The buy of NextLevel Health Partners, if approved, would give Molina more members in Cook County.
By Samantha Liss • Jan. 8, 2020 -
DOJ joins whistleblower suit against Indiana system for alleged Stark violation
Community Health Network is accused of submitting as many as hundreds of thousands of fraudulent claims to Medicare and other federal programs from at least 2008 to 2017.
By Rebecca Pifer Parduhn • Jan. 8, 2020 -
CMS proposes using more encounter data for MA risk adjustment
The mix of encounter data used to calculate payments would go up to 75% next year under the proposed regulation. Payers have railed against previous increases, saying the information is inaccurate and unreliable.
By Shannon Muchmore • Jan. 7, 2020 -
Ex-Anthem exec Brad Smith appointed head of CMS innovation center
Smith, previously co-founder and CEO of palliative care company Aspire Health, replaces outgoing CMMI head Adam Boehler.
By Rebecca Pifer Parduhn • Jan. 7, 2020 -
Supreme Court says ACA opponents have until Friday to respond to motion to expedite
The court set the deadline Monday after a push by the law's supporters to have the case heard before this year's presidential election.
By Samantha Liss • Updated Jan. 7, 2020 -
In win for big payers, appeals court sides with HHS in risk adjustment case
AHIP and the Blues argued it would be inconceivable to come up with an entirely new formula for the payments created under the Affordable Care Act.
By Samantha Liss • Jan. 3, 2020 -
Pfizer, AbbVie and Gilead among drugmakers boosting prices to start 2020
List prices rose on some of the top-selling medicines in the U.S., including Humira, Opdivo, Prevnar 13 and Biktarvy.
By Andrew Dunn • Jan. 2, 2020 -
ACA 2020 enrollment stable but dips slightly
CMS attributed the decline to a few factors, including a strong economy that may have moved more people into job-based coverage and states expanding Medicaid eligibility.
By Ron Shinkman • Dec. 23, 2019 -
Sutter to pay $575M, change contracting practices in antitrust settlement
Pending approval, the deal bars the dominant Northern California system from using all-or-nothing contracts and stops certain bundling practices.
By Shannon Muchmore • Dec. 20, 2019 -
MA value-based plan enrollment tripling for 2020
CMS also moved to fold hospice care into Medicare Advantage, a cost-cutting step industry has expected for a while.
By Rebecca Pifer Parduhn • Dec. 20, 2019 -
With ACA ruling, payers get unexpected short-term reprieve
Analysts say Wednesday's appeals court decision finding the Affordable Care Act's individual mandate unconstitutional is not the worst thing that could have happened for payers — for now.
By Rebecca Pifer Parduhn • Dec. 19, 2019 -
Trump administration lays out plans to import drugs from abroad
But it's not clear how effective importation would be at achieving the administration's goal of reducing drug prices. High-cost drugs like biologics, for example, are excluded from one of the two proposals.
By Ned Pagliarulo • Dec. 18, 2019 -
Providers push back on PhRMA report highlighting 340B program costs
American Hospital Association executive vice president Tom Nickels blasted a new drugmaker-funded study as an "obvious attempt to divert attention away from a problem of their own making: skyrocketing drug prices."
By Rebecca Pifer Parduhn • Dec. 18, 2019 -
Judge refuses to strike down 2020 site-neutral plan — but chides CMS
The federal judge said she lacks jurisdiction to strike down a policy yet to go into effect, but noted the agency's plans for next year disregard her earlier ruling.
By Samantha Liss • Dec. 17, 2019 -
Bruce Bennett via Getty Images
CVS long-term care pharmacy sued by DOJ over fraudulent prescribing practices
The suit is by no means the first time the subsidiary, acquired in 2015 for about $12.7 billion, has been under the federal microscope for fraud.
By Rebecca Pifer Parduhn • Dec. 17, 2019 -
CMS wants to overhaul how organs are procured in the US
The agency estimates if all procurement groups met both the new donation and transplantation rate measures, the number of yearly transplants would shoot up more than 15% by 2026.
By Rebecca Pifer Parduhn • Dec. 17, 2019 -
ACA taxes repealed in year-end spending legislation, with no surprise billing ban
Lawmakers insist a ban on surprise billing will be a top legislative priority for next year, but the spending package does not touch on the issue.
By David Lim • Updated Dec. 23, 2019
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