Payer: Page 87
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Deep Dive
Pharmacogenetic test makers cheer UnitedHealth coverage. Other payers aren't there yet
"I've been concerned that the hype around pharmacogenetics, at least for depression, has gotten out ahead of the data," James Potash, director of psychiatry at Johns Hopkins University, said.
By Graison Dangor • Aug. 28, 2019 -
Dozens of Select Medical LTCHs sue HHS over dual-eligible bad debt
The Provider Reimbursement Review Board refused to reimburse plaintiff hospitals' dual eligible bad debts involving 21 state Medicaid programs.
By Dana Elfin • Aug. 28, 2019 -
Deep Dive
From wellness to well-being: the evolution of employer health initiatives
What started as on-site yoga classes and smoking cessation programs has evolved into something more holistic and wide-reaching.
By Pamela DeLoatch • Aug. 28, 2019 -
CMS updates Medicare Plan Finder following stakeholder pressure
The first iteration has been criticized by myriad stakeholder groups, including the Government Accountability Office, since its 1998 launch.
By Rebecca Pifer Parduhn • Aug. 27, 2019 -
Multiple sclerosis drug costs skyrocketed for Medicare and patients, study finds
Out-of-pocket spending on MS medications increased by more than 600% in the decade from 2006 to 2016, while the typical list price quadrupled.
By Andrew Dunn • Aug. 27, 2019 -
Humana touts wellness program's impact on productivity, cost savings
Though it's hard to quantify the success of such programs, the payer's researchers concluded organizations should expect to see value after three to five years.
By Lisa Burden • Aug. 27, 2019 -
Big 5 payers grow MA market share in August
Despite reports Medicare Advantage is failing to produce savings for taxpayers, big insurers continue to snap up market share. CVS had the strongest year-over-year growth, aided by its acquisition of Aetna.
By Rebecca Pifer Parduhn • Aug. 22, 2019 -
ACA enrollment could stabilize if premiums stay flat
Critics had feared that Republican efforts to undermine the ACA would lead to large decreases in the number of people enrolled in plans sold in the individual insurance market, though a report shows a small decrease in 2019's Q1.
By Linda Wilson • Aug. 22, 2019 -
Wyoming seeks to regulate air ambulances like a public utility
Federal regulations have stymied state efforts to regulate air ambulances. Wyoming is trying a new approach, but first it needs CMS on board.
By Samantha Liss • Aug. 21, 2019 -
Centene, Aetna protest after losing lucrative Louisiana Medicaid contracts
Both insurers called the process bias and tainted. The deals are worth billions.
By Samantha Liss • Aug. 21, 2019 -
Three California networks see promising results in CMS quality initiative
The program reported savings of $345 million over four years in costs that payers would have otherwise incurred from ER visits, hospital admissions, diagnostic tests and other services.
By Linda Wilson • Aug. 21, 2019 -
US task force expands recommended BRCA test population
The Preventive Services Task Force's update potentially boosts business for Myriad Genetics and other BRCA test makers.
By Nick Paul Taylor • Aug. 21, 2019 -
Obamacare exchange consumers stick around longer. Does that mean they're sicker?
The churn expected within the ACA exchanges did occur, though not as fiercely as expected. Now the tide is shifting.
By Samantha Liss • Aug. 20, 2019 -
Kidney transplants jump under Medicaid expansion
A study of more than 15,000 adults with advanced kidney disease showed rates rose after the Affordable Care Act's broadening of coverage, allowing patients access to the pricey procedure.
By Samantha Liss • Aug. 20, 2019 -
Big health plans pledge to look beyond shareholders. Critics aren't so sure
Skeptics call the letter from the Business Roundtable a political stunt in lieu of concrete action. Kaiser Permanente chose not to sign, citing its not-for-profit status.
By Rebecca Pifer Parduhn • Aug. 19, 2019 -
CMS to update hospital star ratings early next year despite blowback
"Republishing the flawed ratings in 2020 will not advance the goal of providing the public with accurate, purposeful information about quality," the American Hospital Association's SVP of policy said.
By Rebecca Pifer Parduhn • Updated Aug. 19, 2019 -
Amgen biosimilar debut boosted by UnitedHealthcare coverage switch
UnitedHealthcare will preferentially cover lower-cost versions of Roche's top-selling cancer drugs, helping Amgen's efforts to gain market share.
By Ned Pagliarulo • Aug. 19, 2019 -
$190 or $47,779? Colorado emergency charges vary wildly across state
But the entire cost of care is likely higher, as the Center for Improving Value in Health Care only looked at direct reimbursement from commercial payers.
By Rebecca Pifer Parduhn • Aug. 19, 2019 -
Medicare Advantage is booming but not producing savings, report finds
At the same time, the Medicare Shared Savings Program is cutting costs, but punitive aspects of the program make it less alluring for providers.
By Samantha Liss • Aug. 19, 2019 -
Price, safety will test blockbuster billing for AbbVie's new arthritis drug
Rinvoq adds another oral option to rheumatologists' tool kits at a list price of $59,000 per year.
By Jacob Bell • Aug. 16, 2019 -
CMS brings controversial star ratings system to ACA plans
Insurance lobby AHIP is not opposed to the rankings, telling Healthcare Dive they're a "positive step" for plan shopping.
By Samantha Liss • Aug. 16, 2019 -
Nation's uninsured rose 700K in Trump's first year
States that refused to expand income eligibility for Medicaid saw the highest increase in uninsured rates.
By Ron Shinkman • Aug. 16, 2019 -
Tufts, Harvard Pilgrim say they intend to merge
The yet-to-be-named combined nonprofit payer will serve 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island.
By Linda Wilson • Aug. 15, 2019 -
Hospitals facing likely DSH payment cuts after appeals court ruling
A federal appeals court reinstated a 2017 rule allowing Medicare and private insurance payments to be included in how Disproportionate Share Hospital reimbursements are calculated.
By Dana Elfin • Aug. 15, 2019 -
Tweaking CMS model variables can improve payment estimates, JAMA study finds
Researchers looked at how to improve predictions for three conditions: acute myocardial infarction, heart failure and pneumonia.
By Dana Elfin • Aug. 14, 2019
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