Payer: Page 89
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Humana accuses Abbott of duping it to pay to remove dodgy heart devices
The suit alleges St. Jude, now a part of Abbott, knew about a defect in its heart rhythm devices for four years before notifying FDA and then schemed to have the insurer pay for surgeries to remove patients' implants.
By Susan Kelly • July 30, 2019 -
Judge nixes New Hampshire's Medicaid work requirement
The ruling is the third time the judge has shot down such demonstration projects, having vacated similar plans in Arkansas and Kentucky on identical grounds.
By Dana Elfin • July 30, 2019 -
CMS proposes forcing hospitals to reveal negotiated rates
Insurer and hospital groups swiftly pushed back against a mandate to publish payer-specific rates for at least 300 services that patients can plan in advance. A legal challenge is likely.
By Samantha Liss • July 30, 2019 -
Sponsored by HMS
COB innovation: Identifying Medicaid 3rd party liability prior to the point of care
Improperly declaring Medicaid as the primary payer when other coverage exists is a seemingly small error that has widespread implications for the healthcare ecosystem.
July 30, 2019 -
CMS will no longer approve full federal funding for partial Medicaid expansion
The policy pivot dashes the hopes of a handful of Republican states looking to receive more federal money for covering fewer people than states with full Medicaid expansion under the Affordable Care Act.
By Rebecca Pifer Parduhn • July 29, 2019 -
Senate advances drug pricing bill, setting up September vote
PhRMA's CEO, along with a number of drugmaker executives, met with President Trump this week to lay out their opposition to the bill.
By Jonathan Gardner • July 26, 2019 -
OIG suggests closer look at impact of rule pushing risk on Medicare ACOs
In another recommendation on the Medicare Shared Savings Program, the watchdog suggested CMS adopt outcomes-based performance measures — rather than process measures — and standardize measures across programs.
By Linda Wilson • July 25, 2019 -
Private equity gobbles up dermatology practices, raising questions about outcomes, costs
An analysis in JAMA Dermatology attempts to illustrate the growth of such PE-backed acquisitions and the spread geographically over time.
By Samantha Liss • July 24, 2019 -
Medicaid coverage cuts mortality rates among low-income adults aged 55 to 64
A National Bureau of Economic Research study of "near-elderly" low-income adults showed Medicaid expansion reduced mortality rates, but future Medicaid expansion is in limbo as the Affordable Care Act is challenged in court.
By Linda Wilson • July 24, 2019 -
As HHS muses more MA flexibility, payers see roadblocks to nonmedical benefits
Implementation challenges, uncertain return on investment and a lack of clarity on what supplemental benefits are allowed are making some payers wary of offering nonmedical services in Medicare Advantage.
By Rebecca Pifer Parduhn • July 24, 2019 -
Anthem blames Medicaid for medical cost bump in Q2
The payer is not alone in reporting an increase in its medical cost ratio for the second quarter, joining its peers Centene and UnitedHealthcare.
By Samantha Liss • July 24, 2019 -
Even $10 increase in Medicaid payments helps erase disparities in care access, study says
Financial incentives influence who a physician decides to treat and their patients' overall health, the National Bureau of Economic Research found.
By Samantha Liss • July 23, 2019 -
Senate committee targets Medicare drug price increases with bipartisan bill
Legislation proposed Tuesday would also reimburse physicians less for administering expensive intravenous drugs to beneficiaries.
By Jonathan Gardner • July 23, 2019 -
CMS' Verma blasts 'Medicare for All,' public option in rhetoric ramp up
The remarks were unusually strong for the CMS leader. Though she has often beat the party drum on plans conservatives call a dangerous step toward socialism, the breadth and specifics of her critique expanded.
By Rebecca Pifer Parduhn • July 23, 2019 -
CVS to test knee replacement program for Aetna beneficiaries
The pilot is the first of a series of broad initiatives the merged health giant is working on, CVS CEO Larry Merlo announced Tuesday at a Medicare Advantage conference.
By Rebecca Pifer Parduhn • July 23, 2019 -
ACA, other coverage expansions not linked with rising hospital use, study shows
Researchers looked at hospital use after introduction of Medicare and Medicaid and after the ACA and concluded universal coverage "is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained."
By Shannon Muchmore • July 23, 2019 -
As ACA exchange members stay longer, Centene sees medical cost bump in Q2
CEO Michael Neidorff clashed with analysts seeking more specificity on margins on an investor call.
By Samantha Liss • July 23, 2019 -
Anthem launches app allowing patients to text with docs
In an on-demand world, the mobile offering is designed to give patients quicker and less expensive access to treatment.
By Samantha Liss • July 22, 2019 -
ACOs with 2-sided risk can cut cost, improve quality, study finds
A Blue Cross Blue Shield of Massachusetts population health program cut per-enrollee spending and resulted in more chronic disease management, according to research in the New England Journal of Medicine.
By Ron Shinkman • July 22, 2019 -
As unprecedented CVS-Aetna review wraps, few clues from judge
Although CVS is now operating and reporting results to Wall Street with Aetna included, the decision could have huge repercussions, especially if the judge orders CVS to go beyond Aetna's divestiture of its Part D business.
By Dana Elfin • July 21, 2019 -
Judge upholds short-term plan expansion in Trump win against ACA
The plaintiffs, including the Association for Community Affiliated Plans, the National Alliance on Mental Illness and AIDS United, appealed the decision upholding the controversial policy Monday.
By Rebecca Pifer Parduhn • Updated July 29, 2019 -
UnitedHealth Q2 revenue growth fueled by Medicare, Optum
The insurance giant's revenues grew 8% year over year to $60.6 billion — a "solid start" to managed care organizations' reporting season, according to Jefferies analysts.
By Rebecca Pifer Parduhn • July 18, 2019 -
High-deductible plans can offer more access to preventive treatment under new rule
Under the guidance, potentially life-saving healthcare services and products used to treat common chronic diseases can be covered as preventive services in high-deductible health plans before enrollees reach their annual deductible.
By Linda Wilson • July 18, 2019 -
Oscar to enter Medicare Advantage market in New York, Texas
For New York residents, the upstart health insurer is planning to sell an MA plan co-branded with Montefiore Health System. In Houston, it intends to partner with multiple providers.
By Shannon Muchmore • July 18, 2019 -
ACA premiums for unsubsidized consumers hit new highs
The average monthly premium for a family of two hit $1,000 per month in 2019, according to eHealth's analysis of data on the unsubsidized market.
By Samantha Liss • July 17, 2019
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