Payer: Page 89
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Maryland's all-payer model shows limited effects for rural hospitals
The facilities had a 9% drop in outpatient visits but no change in inpatient utilization, readmission rate or emergency department visits, according to a new study in Health Services Research.
By Shannon Muchmore • May 13, 2019 -
DOJ moves to block certain witness testimony in CVS-Aetna merger review
The AMA has called economics and health experts Richard Scheffler and Neeraj Sood and antitrust legal expert Tim Greaney as witnesses in the case. The DOJ is seeking to block or limit the testimony of all three.
By Samantha Liss • May 13, 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 -
Insured rate dips again, to 9.4% in 2018
About 1.1 million Americans lost insurance coverage in 2018, according to CDC's annual survey. That puts the total number of uninsured in the U.S. at 30.4 million.
By Tony Abraham • May 10, 2019 -
Payers not entitled to $12B in risk corridors payments, DOJ says
According to a claim filed by government officials Wednesday, the Trump administration doesn't have to shell out the funds because Congress required the Affordable Care Act to be budget-neutral.
By Rebecca Pifer • May 10, 2019 -
Private insurers pay hospitals more than double Medicare rates
The authors of a new RAND study looked at what commercial insurers pay as a percentage of Medicare prices, and found they increased from 235% of Medicare in 2015 to 241% in 2017.
By Samantha Liss • May 10, 2019 -
Massive Anthem hack engineered by China-based group, grand jury says
The payer's speed in notifying the government of the intrusion into its computer systems and cooperation in the investigation helped identify those responsible for the breaches.
By Dana Elfin • May 10, 2019 -
Ford enters NEMT space with national rollout of GoRide Health
The automotive giant is also partnering with the Greater Dayton Regional Transit Authority in Ohio to fill gaps in paratransit services.
By Meg Bryant • May 9, 2019 -
DOJ backs Oscar in antitrust case against Florida BCBS
Florida Blue Cross Blue Shield said no special weight should be given to the government's filing in the case and that "it is not even clear that the Government is entitled to submit a view on this matter at all."
By Samantha Liss • Updated May 20, 2019 -
Trump prods Congress on surprise billing ban
The president called unexpected high-cost medical bills "one of the biggest concerns Americans have about healthcare."
By Shannon Muchmore • May 9, 2019 -
Aetna launches app for Apple Watch
The app is designed to be a "check engine light" for a person's health, Aetna's head of consumer technology told Healthcare Dive.
By Rebecca Pifer • May 8, 2019 -
ACOs less likely to leave Medicare program after 3rd year
Shared-savings bonus payments, higher financial performance benchmarks and lower-risk patients led to longer survival in MSSP, according to a Health Affairs study.
By Rebecca Pifer • May 8, 2019 -
Elizabeth Regan/Healthcare Dive
Drugmakers will soon be required to disclose prices in TV ads
Forcing pharma's hand, the Trump administration finalized a proposal requiring list prices in direct-to-consumer advertising, a move that could result in a legal challenge from industry.
By Ned Pagliarulo • May 8, 2019 -
Payers had best individual market performance in 2018 since ACA began
A Kaiser Family Foundation analysis on the profitability of the ACA individual market also found insurers expect to pay a record amount of rebates to consumers for not meeting the medical loss ratio threshold in 2018.
By Rebecca Pifer • May 8, 2019 -
Kaiser Permanente rolls out EHR-integrated program to tackle social determinants of health
The social health network, a partnership with Unite Us, will be available within three years to all 12.3 million Kaiser Permanente members and the communities it serves, the health system said.
By Meg Bryant • May 7, 2019 -
CMS interstate insurance idea rebuffed by payers, state regulators
Commenters advised the agency against further policymaking on the issue, arguing it could invite a "race to the bottom" that only stands to benefit insurers.
By Tony Abraham • May 7, 2019 -
Centene 'committed' to WellCare deal amid Humana takeover report
Analysts said they doubt such an acquisition would take place and suggested Humana may instead purchase Molina or a smaller Medicaid plan.
By Samantha Liss • May 7, 2019 -
Seniors switching to MA already have lower costs than traditional Medicare beneficiaries
A new Kaiser Family Foundation study raises questions about whether MA payment rates, which are based on spending for similar people in traditional Medicare, are too high.
By Rebecca Pifer • May 7, 2019 -
CMS draft guidance clarifies hospital co-location policy
The American Hospital Association has repeatedly urged the agency to make its policy clear, noting some hospitals were dismantling co-location and shared service arrangements out of concern they would be found noncompliant.
By Meg Bryant • May 6, 2019 -
Insurers' message on 'Medicare for All': We're part of the answer
As CEOs addressed investors on first quarter conference calls, the tone varied, but one message emerged: The private sector has a role to play in healthcare reform.
By Samantha Liss • May 3, 2019 -
People spend less, use fewer services with consumer-directed health plans, study shows
A separate survey found that four in 10 people with employer-sponsored health coverage had trouble paying medical bills, premiums or out-of-pocket costs.
By Meg Bryant • May 3, 2019 -
Taylor McKnight/Healthcare Dive
CBO wades into 'Medicare for All' debate, sidesteps landmines for now
Providers and payers seized on the report to cement their opposition to single-payer policies, but the government agency avoided analysis of any specific plan.
By Tony Abraham • May 2, 2019 -
AHA asks for antitrust probe of Centene-WellCare deal
While Centene CEO Michael Neidorff has downplayed antitrust concerns over the deal, he acknowledged to investors last week that divestitures are likely, specifically in Nebraska and Missouri.
By Shannon Muchmore • May 2, 2019 -
Trump administration asks appeals court to toss entire ACA
DOJ urged the Fifth Circuit to uphold a trial court's ruling finding the law unconstitutional, marking a change for the government, which had previously said the remainder of the ACA was severable from its individual mandate.
By Dana Elfin • May 2, 2019 -
CMS seeks comments on state workarounds to ACA requirements
The agency has gradually pushed states to consider more so-called innovation waivers that can allow them to sidestep key tenets of the ACA in their health insurance markets.
By Rebecca Pifer • May 2, 2019 -
Cigna beats in Q1, but analysts seek detail on Express Scripts
Company officials upped its annual guidance but sidestepped questions over comparing the PBM's business prior to the merger.
By Samantha Liss • May 2, 2019
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