Senators push CMS, commercial payers on bias in algorithms

The letters sent to UnitedHealth, Blue Cross Blue Shield, Cigna, Humana and Aetna flagged a study that found racial bias in a widely used algorithm for assessing healthcare needs.

By Susan Kelly • Dec. 4, 2019

Hospitals sue HHS, warning price transparency rule would chill competition, crash computers

An agency spokeswoman shot back that hospitals "should be ashamed that they aren't willing to provide American patients the cost of a service before they purchase it."

By Samantha Liss • Dec. 4, 2019

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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

Anthem, Passport to protest $7B Kentucky Medicaid contract loss

Aetna, Humana, Molina, UnitedHealthcare and WellCare were the winners in the bid to provide coverage to about 1.3 million Medicaid members.

By Samantha Liss • Dec. 3, 2019

Centene sells Illinois plans to CVS in next step for WellCare buy

Centene has already divested its Medicaid managed care business in Nebraska and Missouri as it nears completion of the $17 billion acquisition of its rival.

By Samantha Liss • Dec. 2, 2019

Global Blood's sickle cell drug wins FDA approval, joining Novartis' Adakveo

A list price of roughly $10,000 a month puts Global Blood's Oxbryta slightly higher than what Novartis' Adakveo will cost.

By Jonathan Gardner • Nov. 26, 2019

Walgreens, UnitedHealthcare team up to open in-store Medicare centers

The move comes as rival retailers like CVS and Walmart devote more floor space to health services. The 14 stores will open next year in five metro areas.

By Samantha Liss • Nov. 26, 2019

Standards body urged to add device identifiers to insurance claims forms

Advocates say such a policy change would improve patient safety and save the healthcare system money by allowing better tracking of implants by brand and model.

By Susan Kelly • Nov. 26, 2019

Mandatory CMS radiation oncology model goes on backburner

Originally, the agency was eyeing an implementation date as early as Jan. 1, but the new regulatory agenda lists July 2022 as a target date for the bundled payment model.

By David Lim • Nov. 26, 2019

Myth Diagnosis: Is healthcare recession-proof?

"That's a little bit of a misnomer," Ben Isgur, health researcher at PwC, told Healthcare Dive. "It is a little recession-resistant, but eventually that wears off."

By Shannon Muchmore • Nov. 22, 2019

Hospital market power shares blame for mushrooming middle-class health costs, Commonwealth Fund says

"There is very little restraint on pricing," the research group's president David Blumenthal said. Hospitals are motivated to boost prices to offset declining rates of inpatient utilization, particularly if they have excess capacity, he added.

By Linda Wilson • Nov. 21, 2019

Providers take next step in social determinants: hyperlocalism

Industry can "help others have an uncomfortable dialogue about what is truly driving health outcomes in this country," Atrium Health's Alisahah Cole said at the Healthcare of Tomorrow conference.

By Shannon Muchmore • Nov. 19, 2019

Hospitals pledge to fight Trump admin price transparency plan in court

President Donald Trump said patients have "been getting ripped off for years" and HHS Secretary Alex Azar said the requirements are a "revolutionary" change for the industry.

By Samantha Liss , Shannon Muchmore • Nov. 18, 2019

Hospitals — and now insurers — to reveal secret rates under latest Trump admin pitch

Industry lobbies have argued the government lacks authority to issue such mandates and are sure to fight back against what would be a landmark shift in healthcare.

By Samantha Liss • Nov. 15, 2019

The value-based care crossroad: How health plans can remain on course

Why are providers finding the transition from traditional fee-for-service to newer value-based care models to be such a bumpy road?

Nov. 14, 2019

Providers shell out $2.76B annually to update directories

Medical practices spend nearly $1,000 per month updating lists of insurers' in-network providers, according to a new report from an alliance of big payers.

By Linda Wilson • Nov. 14, 2019

ICER draws new gene therapy pricing framework

One-time and short-term curative therapies require a different approach to evaluating benefit, the cost watchdog group said. 

By Jonathan Gardner • Nov. 13, 2019

CMS pitches ramped up oversight of Medicaid payments, promises block grant guidance

Provider lobbies clapped back Wednesday against the proposed rule, with America's Essential Hospitals calling it a "deeply damaging" policy that would erode state flexibility and the medical safety net.

By Rebecca Pifer Parduhn • Updated Nov. 13, 2019

Kaiser Permanente net income tops $1B, margins sag

Unions have cited the not-for-profit's hefty income to push for better working conditions. CFO Kathy Lancaster defended the profits, which she said "allows us to make investments in technology, infrastructure, and our people."

By Linda Wilson • Nov. 12, 2019

Surprise billing services had higher-than-average markups

Annual price bumps were greatest at for-profit hospitals, those that served more uninsured patients (for emergency medicine services) and facilities in the Southeast, according to a research letter in JAMA Internal Medicine.​

By Shannon Muchmore • Nov. 11, 2019

From telehealth to 'Medicare for All': takeaways from HLTH19

All of Healthcare Dive's coverage from the health innovation conference's second year.

Nov. 8, 2019

Behind insurer strategies to snag higher MA star ratings

Last year, more than $6 billion in bonuses were awarded to various types of Medicare Advantage plans. Payers like Cigna and Kaiser say they don't teach to the test, but they do value the rankings.

By Samantha Liss • Nov. 7, 2019

Hospital M&A spurs rising healthcare costs, MedPAC finds

Adding to a growing body of evidence, the Medicare Payment Advisory Commission found providers with greater market share see higher commercial profit margins, leading to higher costs per discharge.

By Rebecca Pifer Parduhn • Nov. 7, 2019

Retail makes its case, telehealth and voice tech dominate: 6 takeaways from HLTH19

Consumerism has its limits, interoperability rules face execution challenges and more from Las Vegas.

By Rebecca Pifer Parduhn • Nov. 6, 2019

Humana trims costs, workforce as it readies for health insurance fee

The payer's third quarter results exceeded management's expectations. The company raised its guidance for the full year, fueled by growth in its Medicare Advantage segment.

By Samantha Liss • Nov. 6, 2019

CVS profit up 10% thanks to Aetna; warns Q4 won't be as rosy

The company beat Wall Street earnings and revenue estimates in the third quarter, causing it to raise its full-year guidance and sending its stock up almost 5% Wednesday morning.

By Rebecca Pifer Parduhn • Nov. 6, 2019