Republican bid to dismantle ACA takes center stage

A federal appeals court in New Orleans heard oral arguments Tuesday in a ruling that could send ripples across the industry.

By Dana Elfin • July 8, 2019

DOJ, House, states tell appeals court it has authority to hear ACA case

Ahead of Tuesday's oral argument, parties in the appeal over the constitutionality of the Affordable Care Act filed briefs telling the court it has jurisdiction because a live controversy exists.

By Dana Elfin • July 8, 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

Healthcare Dive's 10 biggest stories of the spring

From Amazon pushing into the prescription delivery sector to CVS-Aetna struggling to finalize their merger settlement agreement, read the top stories from the first half of the year.

By Rebecca Pifer • July 8, 2019

Doctors significantly over-allocated times to perform joint replacements, study shows

Time periods estimated to perform medical procedures, known as relative value units, are crucial for determining how much surgeons and other doctors are paid for their work under the Medicare Physician Fee Schedule.

By Ron Shinkman • July 3, 2019

Zolgensma set a new drug pricing bar. Insurers show some signs of pushback

One month after approval, a handful of payers — including Anthem — have adopted policies taking a more cautious stance than what the FDA set out in the gene therapy's label.

By Ned Pagliarulo • July 3, 2019

ACOs may need stronger financial incentives, like downside risk, to succeed

The proportion of ACOs taking downside risk has inched up in recent years but still represents a minority, a study published in Health Affairs found.

By Rebecca Pifer • July 3, 2019

Could NEMT's pivot to the commercial sector be a wrong turn?

Employers and commercial plans are increasingly looking to partner with players like Uber and Lyft for non-emergency medical transportation, raising thorny questions about the return on investment in a healthier population.

By Rebecca Pifer • July 2, 2019

Air ambulance charges soar over most other providers

A new study in Health Affairs examines the price air ambulances charge Medicare, an important figure that reveals the potential financial exposure some patients may face if they receive a surprise, out-of-network bill. 

By Samantha Liss • July 1, 2019

Hospitals saved $1K per episode under joint replacement bundled model

Most participating hospitals received reconciliation payments in at least one of the program's first two years. Those getting the bonus tended to have higher quality scores, more episodes of care and lower patient complexity.

By Shannon Muchmore • July 1, 2019

ACA insurers remain profitable despite policy changes

"Earlier concerns that the market would collapse or insurer exits would lead to counties with no coverage available at all have proven unfounded," according to a new Kaiser Family Foundation report.

By Samantha Liss • July 1, 2019

Aiming for price transparency, Civica Rx hits snag with bundled payments

The payment model, often opaque on specific drug costs, affects many of the medicines the hospital-led group is targeting, according to commercial chief Heather Wall.

By Jacob Bell • June 27, 2019

CMS clears Louisiana Medicaid 'Netflix model' for hep C drugs

The subscription model will go into effect Monday, coming after the state inked a five-year partnership with a Gilead subsidiary to manufacture the treatment.

By Rebecca Pifer • June 26, 2019

MA patients' readmission rates higher than traditional Medicare, study finds

A study in the Annals of Internal Medicine adds to a growing body of research analyzing the Medicare Hospital Readmission Reduction Program's effect on patient outcomes.

By Linda Wilson • June 26, 2019

Samsung Bioepis CEO urges patience as US biosimilar market lags

"Market shaping takes time," the head of the Korean drugmaker said, as a few experts propose giving up on the copycat biologics altogether.

By Ned Pagliarulo • June 26, 2019

Majority of patients faced out-of-pocket expense of $500 or more last year

Out-of-pocket costs are increasing even as patients shift to less expensive care settings, according to a new report from TransUnion Healthcare.

By Samantha Liss • June 26, 2019

Hospital price transparency push draws industry ire, but effects likely limited

While few would argue for secrecy for its own sake, policy analysts say there's little evidence patients use the information now available to make decisions that could bend the cost curve.

By Shannon Muchmore • June 25, 2019

Shareholders overwhelmingly approve Centene-WellCare union

This isn't the final hurdle for the $17 billion deal, which still awaits approval from more than 20 states.

By Samantha Liss • Updated June 25, 2019

UPMC, Highmark ink 10-year contract after years of fighting

The reconciliation comes less than a week before a deadline that would cut off Highmark-insured patients from access to many UPMC facilities.

By Rebecca Pifer • June 25, 2019

Supreme Court to hear $12B risk corridor case next term

The Chamber of Commerce urged the court to take the case, warning that if the government is allowed to renege on its promised payments it could scare off the business community from working with the government.

By Dana Elfin • June 25, 2019

CVS, government urge federal judge to bless settlement pact

Attorneys general from five states reaffirmed their support this week of the Justice Department's settlement with CVS over its acquisition of Aetna. Oral argument is set for later this month.

By Dana Elfin • Updated July 2, 2019

Trump order to force hospitals to reveal information behind negotiated rates

Providers and payers will be required to give patients estimates for out-of-pockets costs for procedures in advance under an executive order the president is expected to sign Monday. A legal challenge is likely.

By Shannon Muchmore • June 24, 2019

AHIP19: Insurers acknowledge heightened cost pressures

"We really do have to tackle head on the issue of affordability," Matt Eyles, CEO of AHIP, said during the lobby's annual conference.

By Samantha Liss • June 24, 2019

Not 'a build it and they will come kind of thing': Telehealth descends on AHIP19

Doctor on Demand and Teladoc were among the telehealth players that descended on the insurance industry's annual meeting to tout services aimed at helping payers bend the cost curve.

By Kim Dixon • June 21, 2019

Surprise billing fixes would ding hospitals, staffing companies, Moody's says

Legislative proposals to end the practice of surprise billing are mostly credit negative for providers, but fixes that include bundled billing or an in-network guarantee would have the worst effect.

By Rebecca Pifer • June 21, 2019

Social determinants of health the buzzword at AHIP19

A new initiative aims to bring together payers from different markets and geographies to work together on establishing programs to combat social inequities that negatively affect health.

By Samantha Liss • June 21, 2019