Payer: Page 84
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Culling surprise billing would save $40B annually, Health Affairs study finds
The research also found that out-of-network billing was most common at for-profit hospitals and in areas with highly concentrated provider and payer markets.
By Shannon Muchmore • Dec. 16, 2019 -
BCBS of Michigan cuts new value payment deal with 7 major systems
The model will apply to roughly 30% of the payer's total commercial and Medicare Advantage market. Health systems that have signed on include Ascension Michigan, Henry Ford Health System and Trinity Health.
By Samantha Liss • Dec. 16, 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 -
Humana to acquire hospice pharmacy, PBM Enclara
The Louisville, Kentucky-based payer is looking to round out its pharmacy offerings for high-need patients.
By Rebecca Pifer Parduhn • Dec. 16, 2019 -
HHS watchdog accuses MA plans of inflating payments by nearly $7B annually
The apparent overpayments are tied to payers tacking on new diagnosis codes as part of a review of existing medical charts, a practice CMS is encouraged to watch more closely.
By Ron Shinkman • Dec. 13, 2019 -
Livongo, Propeller, Omada tapped for Express Scripts digital health formulary
The PBM presented the formulary as a way for health plans and employers to access digital health products that have been vetted for effectiveness, security and value.
By Nick Paul Taylor • Dec. 13, 2019 -
Samantha Liss/Healthcare Dive
Centene quietly lobbying Congress to let states partially expand Medicaid
Centene wants to lower the eligibility on Medicaid expansion populations from 138% to 100% of the federal poverty level, ultimately pushing more people into the ACA exchanges.
By Samantha Liss • Dec. 12, 2019 -
Amid legal roadblocks, CMS clears South Carolina Medicaid work mandates
The administration has approved work requirements in ten states so far, though three (New Hampshire, Kentucky and Arkansas) have seen their programs struck down by a federal judge.
By Rebecca Pifer Parduhn • Dec. 12, 2019 -
Getty / Edited by BioPharma Dive
Value-based pricing for gene therapy? Maybe not ready for hemophilia
Small patient population plus large potential savings could make blood clotting gene therapies an easier sell to payers, biotech execs say.
By Jonathan Gardner • Dec. 12, 2019 -
CVS launches precision medicine program for oncology
Executives have teased a cancer care pilot for much of this year as they look for ways to capitalize on overlap between retail locations and Aetna.
By Rebecca Pifer Parduhn • Dec. 12, 2019 -
Health insurers stable, M&A seen diminishing in 2020: Fitch
Despite a projected increase in the growth of U.S. health spending, the ratings agency expects insurers to deliver healthy operating results including improved medical loss ratios for 2020.
By Samantha Liss • Dec. 11, 2019 -
Amazon's PillPack inks 1st digital pact with payer in BCBS Massachusetts
The Blues plan will target the offering to the 12% of its beneficiaries that take five or more maintenance medications, and the 43% that take between two and four, a spokesperson told Healthcare Dive.
By Rebecca Pifer Parduhn • Dec. 11, 2019 -
Kaiser interim chief Greg Adams named full-time CEO
Adams has been at the nonprofit for over two decades and previously served as a group president overseeing hospital and health plan operations, including Kaiser's Medicare care delivery strategy.
By Rebecca Pifer Parduhn • Dec. 11, 2019 -
Few Medicare Advantage plans add new benefits for serious illness
Starting this year, CMS gave the plans flexibility to offer more benefits for nonmedical services like home-based palliative care, adult daycare services, bathroom safety devices and modifications.
By Linda Wilson • Dec. 11, 2019 -
Health insurance coverage linked to reduced mortality
In a sweeping study of millions of households, researchers found that people were more likely to sign up for health insurance once prodded.
By Samantha Liss • Dec. 10, 2019 -
Surprise billing ban draft: Middle ground leaves few pleased
The bill backed by a bipartisan group of Senate and House leadership would require insurers pay at least the median in-network negotiated rate for the area market for out-of-network services and has an arbitration backstop.
By Shannon Muchmore • Dec. 10, 2019 -
Competing House surprise billing plan muddies path of White House-backed legislation
The House Ways and Means Committee unveiled its own surprise billing legislation Wednesday that relies on arbitration.
By Shannon Muchmore • Updated Dec. 12, 2019 -
UnitedHealth to acquire embattled specialty pharmacy Diplomat for $300M
Four separate lawsuits are attempting to enjoin the purchase, the payer said this week. The cases allege information about the deal was held back from Diplomat shareholders, including financial data.
By Rebecca Pifer Parduhn • Updated Jan. 24, 2020 -
Samantha Liss/Healthcare Dive
Dive Awards
Payer of the Year: Centene
Centene's blockbuster acquisition of WellCare doubled its Medicare Advantage footprint and positions the company to be the leader of government-sponsored plans.
By Samantha Liss • Dec. 9, 2019 -
Dive Awards
Executive of the Year: Larry Merlo, CVS Health
Merlo has a vision for the future of the industry, and he's leveraging all of the retail giant's many assets to try and get there.
By Rebecca Pifer Parduhn • Dec. 9, 2019 -
Yujin Kim/Healthcare Dive
Dive Awards
The Healthcare Dive Awards for 2019
From the Affordable Care Act lawsuit to CVS Health CEO Larry Merlo, these are the companies, executives and movements that shaped U.S. healthcare this year.
Dec. 9, 2019 -
Value-based care payments increasing but risk still rare
Bundled payment adoption, for example, remained flat between 2012 and 2017 despite studies showing their promise in holding down costs, the Catalyst for Payment Reform found.
By Ron Shinkman • Dec. 6, 2019 -
More than 1K employers push Senate to repeal ACA Cadillac tax
AHIP and the U.S. Chamber of Commerce were among those arguing the tax will have sweeping effects beyond just "gold-plated" health coverage and will raise costs for the millions of Americans with employer coverage.
By Rebecca Pifer Parduhn • Dec. 6, 2019 -
US healthcare spending growth rebounded last year, influenced by insurance tax
Hospital and physician and clinical services spending fell, but prices were up. CMS Administrator Seema Verma blamed provider consolidation and the "creation of monopolies."
By Shannon Muchmore • Dec. 5, 2019 -
Medicare Advantage members rarely review or switch plans
A Kaiser Family Foundation analysis found that more than one in three Medicare beneficiaries reported difficulty comparing plan options and nearly half of those on Medicare said they rarely or never review their choices.
By Shannon Muchmore • Dec. 4, 2019 -
Deep Dive
Will sky-high drug prices spur the US to use an obscure power over patents?
New cell therapies as well as gene-based treatments like Zolgensma benefited from NIH funding of early-stage research. Advocates say the time is now for the government to invoke its "march-in" rights.
By Jonathan Gardner • Dec. 4, 2019
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