Payer: Page 90
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Yujin Kim/Healthcare Dive
At gene therapy meeting, insurance execs grapple with expected cost
As more gene therapies move closer to market, questions around pricing and reimbursement have taken on greater urgency for regulators, payers and drugmakers.
By Ned Pagliarulo • May 1, 2019 -
Humana beats Q1 expectations as MA growth continues
CEO Bruce Broussard on Wednesday became the latest payer chief to speak out against "Medicare for All" type plans and highlighted the threat they pose to the Medicare Advantage market.
By Tony Abraham • May 1, 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 -
Aetna boosts CVS Q1 beat
The first full quarter with Aetna under its umbrella, as well as increased prescription drug volume, helped fuel revenue growth for CVS.
By Samantha Liss • May 1, 2019 -
Civica Rx CEO predicts 'stampede' if Amazon's Haven succeeds
Others attending the World Healthcare Congress on Monday agreed, with Stanford Graduate School of Business professor Robert Pearl saying "disruption is inevitable."
By Rebecca Pifer • April 30, 2019 -
More Medicaid insurers could be ticket to lowering premiums in ACA markets
An Urban Institute and Robert Wood Johnson Foundation report shows a correlation between states with lower premiums and broad Medicaid managed care coverage within the state.
By Meg Bryant • April 30, 2019 -
Once an albatross, Molina boasts 16% ACA margins
First-quarter earnings bested Wall Street's estimates, with net income soaring 85% to $198 million. The company reported a 9% dip in premium revenue, though executives said this was in line with their expectations.
By Samantha Liss • April 29, 2019 -
Prior authorization harms care, outcomes, radiation oncologists contend
Of the radiation oncologists polled by the American Society for Radiation Oncology, 93% said PA delays their patients from receiving life-saving treatment.
By Les Masterson • April 29, 2019 -
Deductibles soar in small business health insurance market
Small companies are turning to plans with restricted provider networks as a way to contain healthcare costs, insurance broker eHealth found.
By Les Masterson • April 29, 2019 -
Legacy systems, employee error leave hospitals, devices vulnerable to cyberattacks
Improper handling and storage of patient files, often due to poor organizational policies and procedures, can give hackers the upper hand over healthcare organizations, according to new research from threat detection firm Vectra.
By Meg Bryant • April 26, 2019 -
ACA could cushion payers during next recession: Moody's
While health insurers wouldn't be able to avoid taking a hit from lower employment levels, the rating agency's research shows Medicaid expansions and the ACA exchanges create protections the companies didn't have in 2008.
By Tony Abraham • April 26, 2019 -
FTC accuses Surescripts of monopolizing e-prescribing markets
The commission alleges the health IT vendor, owned by some of the biggest PBMs and pharmacies, used exclusivity agreements and threats to stop customers from using other platforms.
By Shannon Muchmore • April 25, 2019 -
Humana, Doctor On Demand launch virtual primary care plan
The new plan, called On Hand, includes a dedicated primary care provider and low copays.
By Meg Bryant • April 25, 2019 -
CMS urges state Medicaid programs to test new dual eligible care models
The agency lamented the lack of care coordination for the dual eligible population that leads to "misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all."
By Les Masterson • April 25, 2019 -
Hospitals, doctors and Gawande laud new CMS primary care model, but will practices stay?
The agency set an ambitious goal of enrolling a quarter of all traditional Medicare fee-for-service providers and beneficiaries in the new model. The program, however, is voluntary, and some paths carry significant downside risk.
By Shannon Muchmore • April 24, 2019 -
Membership increases drive Anthem's Q1 revenue growth above 9%
The insurance giant raised its earnings outlook for the full year but refrained from joining other payers weighing in on "Medicare for All."
By Samantha Liss • April 24, 2019 -
CMS details new primary care payment model with range of risk options
The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the voluntary five-year program, called Primary Cares Initiative.
By Shannon Muchmore • April 23, 2019 -
Medicare spending to snowball to 6% of GDP in next 2 decades, trustees predict
It's "striking" how Congress has ignored the warning signs of runaway spending, Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy, told Healthcare Dive.
By Rebecca Pifer • April 23, 2019 -
Centene's membership growth fuels Q1 as CEO updates divestiture plan
The payer upped its 2019 guidance after beating analyst expectations on revenue and earnings.
By Samantha Liss • April 23, 2019 -
Surprise billing, drug rebates among likely reforms this year, S&P Global says
ACA repeal efforts and "Medicare for All," however, have little chance of advancing in the current political landscape, according to a new report.
By Meg Bryant • April 22, 2019 -
CMS makes no change to silver loading, finalizes lower ACA exchange fees
The final rule for 2020 exchange plans also allows insurers to forgo applying drug manufacturer coupons toward patient out-of-pocket cost limits when a brand name drug has a generic alternative available.
By Shannon Muchmore • April 22, 2019 -
Fewer uninsured ED visits, hospitalizations after ACA, JAMA study finds
The report also credited recent trends like new payment models for the decrease, as well as growing hospital ED alternatives such as urgent care clinics, freestanding emergency rooms and telemedicine.
By Les Masterson • April 22, 2019 -
Physician telehealth use up 340% since 2015, survey finds
Among specialties with high burnout rates, willingness to use telehealth runs high but actual use is still low, according to the American Well report.
By Meg Bryant • April 17, 2019 -
Chronic illnesses will play even bigger role in healthcare in coming years
Conditions like diabetes, cardiovascular disease, arthritis, Alzheimer's disease, obesity and cancer cost more than $1 trillion annually.
By Les Masterson • April 17, 2019 -
Humana rolls out oncology payment model
Sixteen practices are participating in the inaugural test of the model, which began in January across 11 states.
By Rebecca Pifer • April 17, 2019 -
UnitedHealth CEO's 'Medicare for All' bashing sends payer, provider shares tumbling
The biggest private payer beat Wall Street expectations on Tuesday, but a rebuke of plans to expand Medicare weighed on health companies.
By Samantha Liss • April 17, 2019
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