Payer: Page 87
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Oscar files appeal in battle with Florida Blue over exclusive broker policies
A federal judge ruled against the startup last month, despite the U.S. Department of Justice arguing the case should not be tossed.
By Samantha Liss • Oct. 15, 2019 -
CMS issues 2020 star ratings for Medicare Advantage plans; Kaiser dominates
Centene and WellCare did not fare so well as the two attempt to wrap up their merger, a finding one analyst called "less-than-inspiring."
By Ron Shinkman • Oct. 14, 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 -
As Medicaid work requirements cost taxpayers $408M, government watchdog calls for more oversight
"More money, fewer people with care. And you paid for 87% of it!" Andy Slavitt, who headed up CMS under former President Barack Obama, tweeted of the administrative costs associated with Medicaid work requirements.
By Samantha Liss • Oct. 11, 2019 -
UnitedHealth doubles down on telemedicine with app in employer-sponsored plans
The insurer currently contracts with Teladoc, American Well and Doctor on Demand to offer virtual visits, though it is in talks to partner with local providers.
By Rebecca Pifer Parduhn • Oct. 10, 2019 -
For COPD patients with high deductibles, more trouble getting care
Authors of the study said plans that "raise out-of-pocket costs or give individuals more 'skin in the game' could harm patients."
By Shannon Muchmore • Oct. 10, 2019 -
Fresenius to pay $5.2M to settle Medicare overbilling allegations
DOJ alleged the company overbilled Medicare for more than seven years by ordering hepatitis B tests for patients it knew to be immune to the virus.
By Nick Paul Taylor • Oct. 10, 2019 -
Elizabeth Regan/Healthcare Dive
With new report, ICER puts itself at center of drug pricing storm
Pharma price hikes added billions of dollars to U.S. spending in 2017 and 2018. For seven top drugs, the watchdog found those increases came with little new clinical evidence in support.
By Ned Pagliarulo • Updated Oct. 8, 2019 -
Colorado's public option plan cuts provider rates to lower premiums
The state hospital association immediately slammed the proposal as akin to government rate-setting with "the potential to significantly damage the health insurance market in our state."
By Rebecca Pifer Parduhn • Oct. 9, 2019 -
Former FDA chief Gottlieb predicts Trump-pitched pricing model easy to game
"I don't want to give too much away, because I'll tell people how to game around this," said the former commissioner, who now sits on Pfizer's board of directors.
By Andrew Dunn • Oct. 9, 2019 -
Sponsored by Geneia LLC
How to use AI to reduce diabetes costs
Using AI to predict which type 2 diabetics will experience a diabetes-related complication can help payers save millions of dollars.
By Jasmine McCammon, Ph.D., Geneia Principal Data Scientist • Oct. 9, 2019 -
PPO? Co-pay? Cigna tries to explain health coverage to new members
"The ACA was really able to open the doors for a segment of the population that had really limited knowledge about how health insurance works," said Manish Naik, who leads the individual and family plans business for the payer.
By Samantha Liss • Oct. 8, 2019 -
Startup Devoted says it's 1st MA plan to offer Apple Watch
It's not the first time Apple has made a wearables deal with an insurer, but does represent the tech giant's first concrete foray into Medicare Advantage.
By Rebecca Pifer Parduhn • Oct. 8, 2019 -
Livongo scores biggest diabetes contract yet
Investors reacted to the news of the BCBS federal employee program agreement by bumping up Livongo's shares more than 18%.
By Nick Paul Taylor • Oct. 8, 2019 -
Trump signs executive order bolstering MA in pushback on 'Medicare for All'
The directive would let commercial Medicare plans offer more novel benefits and allow beneficiaries to join in on some of the savings payers are able to deliver through cash or rebates.
By Samantha Liss • Oct. 3, 2019 -
Walmart pilot will steer employees to local, high-quality docs
The country's largest private employer is trialing the program in Northwest Arkansas, Orlando and Tampa in Florida, and the Dallas-Fort Worth area.
By Rebecca Pifer Parduhn • Oct. 3, 2019 -
Ramping up rhetoric against 'Medicare for All,' Trump looks to bolster popular MA program
Though administration officials were light on details, they said an executive order the president will sign Thursday aims to expand access to healthcare providers and the latest therapies.
By Samantha Liss • Oct. 3, 2019 -
ACOs taking on risk performed better in Medicare program last year
Participants generated nearly $740 million in savings under the model, and most also earned quality improvement rewards.
By Shannon Muchmore • Oct. 2, 2019 -
Payers roll out 2020 MA plans with increased focus on social determinants
"Clearly, Medicare Advantage has the ability and the opportunity to innovate in ways that's just harder under fee-for-service," said Sean Creighton, managing director with Avalere.
By Shannon Muchmore • Oct. 2, 2019 -
'A radical experiment': Payers, providers renew attacks on price transparency proposal
Industry groups skewered the rule as "the wrong approach," "anticompetitive," "confusing" and "missing the mark."
By Rebecca Pifer Parduhn • Sept. 30, 2019 -
After California surprise billing law, fewer specialty services were out-of-network
The new report "strongly contradicts" the California Hospital Association's claims the law is destroying provider networks, a study author said.
By Shannon Muchmore • Sept. 27, 2019 -
UnitedHealthcare says more consumers are shopping around for healthcare
The payer's latest survey suggests larger numbers of Americans are comparing prices for healthcare and switching providers based on what they find. But the survey didn't delve into the many obstacles around finding accurate prices.
By Ron Shinkman • Sept. 26, 2019 -
Anthem scoops up Centene-WellCare divestitures
Anthem is expected to pick up nearly 300,000 new Medicaid members through the acquisitions, according to state enrollment data.
By Samantha Liss • Sept. 26, 2019 -
Walmart's Sam's Club teams with Humana in worker discount program
The pilot offering four bundled plans also involves on-demand primary care app 98point6.
By Rebecca Pifer Parduhn • Sept. 26, 2019 -
Worker health insurance costs surpass wage growth, survey finds
"This survey underscores for me why for most Americans the issue is affordability much more than it is expanding coverage. And it really is just math," Kaiser Family Foundation CEO Drew Altman said of the results.
By Linda Wilson • Sept. 26, 2019 -
Verma touts MA premium drop, chastises payers for complacency
"Consumers are frustrated and fed up. And to address the elephant in the room, they are frustrated with you," the CMS administrator said, pointing to surprise billing, denying care and the complexity of the system.
By Samantha Liss • Sept. 25, 2019
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