Payer: Page 91
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Nearly all states using value-based payment models
Researchers commissioned by health IT firm Change Healthcare found 34 states have initiatives that are two years or older. Just four states have no official value program: Georgia, Indiana, Mississippi and West Virginia.
By Shannon Muchmore • April 16, 2019 -
MA growth helps fuel UnitedHealth's 9% Q1 revenue bump
The payer raised its earnings expectations for the year, while also taking a shot at calls for movement toward a Medicare for all type insurance system.
By Samantha Liss • April 16, 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 -
Primary care accounts for small fraction of Medicare spending
Primary care spending percentages were lower for more vulnerable beneficiaries and varied by state, according to a new report by RAND.
By Les Masterson • April 16, 2019 -
Sutter to pay $30M to settle Medicare Advantage overpayment allegations
An HHS OIG official said "large health systems can expect a thorough investigation of claimed enrollees' health status," as MA plans become more popular.
By Samantha Liss • April 15, 2019 -
GM exec calls for more pressure on consolidating healthcare companies
The healthcare leader for the car giant put Cigna on defense about whether the payer's combination with Express Scripts will result in lower costs.
By Samantha Liss • April 12, 2019 -
Healthcare again tops industries for cybersecurity attacks, data breaches
Breach notifications triggered 34 investigations by the HHS Office for Civil Rights in 2018, up from 22 the previous year.
By Meg Bryant • April 11, 2019 -
Digital care coordination software market to top $3B by 2022, but hurdles remain
Driving growth is poor referral management, a desire for real-time communication on patient outcomes and potential savings from improving chronic disease management, according to a report from Frost & Sullivan.
By Meg Bryant • April 11, 2019 -
Medicaid reimbursement, not expansion status, affects doctors' acceptance of new patients
The percentage of providers willing to take on new Medicaid patients also did not change based on a state's Medicaid managed care offerings, according to an analysis of MACPAC data.
By Les Masterson • April 11, 2019 -
Texas Blue, Sanitas USA to open 10 primary care clinics in Dallas, Houston
Services at the new "one-stop medical centers" will be available to Blue Cross and Blue Shield cardholders, along with self-pay patients and Medicare fee-for-service beneficiaries.
By Rebecca Pifer • April 10, 2019 -
PBMs escape Senate hearing largely unscathed
Testifying before the Senate Finance Committee on Tuesday, executives from Cigna, CVS Caremark and other PBMs stuck to their familiar tune of blaming manufacturer list prices for fueling skyrocketing prices.
By Samantha Liss • April 10, 2019 -
UnitedHealthcare expands MA bundled payment plan offerings for 2020
The payer estimates it will have $75 billion in annual provider reimbursements tied to value-based arrangements by the end of next year.
By Rebecca Pifer • April 10, 2019 -
Most hospitals provide electronic access to records, but patients slow to engage, ONC says
More than half of U.S. hospitals enabled patients to electronically request prescription refills in 2017 — up from just over a quarter in 2013, according to a new report.
By Meg Bryant • April 9, 2019 -
Healthcare administrative costs will tally nearly $500B this year
The price tag includes $158 billion in private insurance overhead, $56 billion for public insurance program administration and $282 billion for providers' billing and insurance-related costs, according to the Center for American Progress.
By Rebecca Pifer • April 9, 2019 -
Emergency department visits rose, but misuse fell in 2016
Wait times improved, according to the CDC data. Nearly 40% of patients had wait times of less than 15 minutes and 72% waited less than an hour.
By Les Masterson • April 8, 2019 -
CMS gives MA plans telehealth boost with expanded benefits
Building on recently finalized policies to expand supplemental benefits, the rule also seeks to update star ratings methodology and improve the appeals process for dual eligible beneficiaries.
By Tony Abraham • April 8, 2019 -
340B program leads to higher costs, PhRMA-commissioned report finds
The research conducted by Berkeley Research Group is the latest skirmish in a battle over the program, which health systems argue helps safety net hospitals access affordable prescription drugs.
By Les Masterson • April 8, 2019 -
MedPAC wants to redesign MA quality bonus program
The advisory commission also voted Thursday to recommend Congress pass legislation to withhold some Medicare Advantage plan payments if an insurer's encounter data is wrong or incomplete.
By Rebecca Pifer • April 5, 2019 -
CVS-Aetna judge to hear testimony from critics next month
The American Medical Association is expected to be among the witnesses called as the federal judge tasked with approving the merger agreement between the companies and the DOJ drags out his review.
By Samantha Liss • Updated April 23, 2019 -
PBM group says HHS drug rebate proposal would increase costs more than predicted
However, Fitch Ratings said in a new forecast it doesn't expect the change will have a long-term impact on margins or profits for payers, drug companies or distributors.
By Les Masterson • April 5, 2019 -
Amazon's Alexa now has HIPAA-compliant features
Six companies taking part in the online giant's invitation-only developer program launched their features Thursday, including Atrium Health, Cigna, Express Scripts and Livongo.
By Shannon Muchmore • April 4, 2019 -
Alex Wong via Getty Images
CMS approves Maine's long-awaited Medicaid expansion
The state's voters approved expansion in November 2017 for implementation no later than July 2018. However, then-governor Paul LePage, a Republican, refused to carry out the measure last year.
By Rebecca Pifer • April 4, 2019 -
Medicaid expansion improves community health center finances, access to care
Centers in the three dozen expansion states are more likely to offer behavioral health counseling and coordinated care than non-expansion states, according to The Commonwealth Fund.
By Les Masterson • April 4, 2019 -
Industry groups seek cybersecurity safe harbor
In response to a senator's request, several organizations highlighted the need for a national strategy and greater collaboration among various stakeholders, according to a think tank that read the responses.
By Meg Bryant • April 3, 2019 -
Americans' healthcare paradox: 'angst' on costs, overconfidence on quality
Nearly 70% of Americans are "not at all" confident that politicians will be able to pass legislation to lower healthcare costs, according to a new West Health and Gallup survey.
By Rebecca Pifer • April 3, 2019 -
More care shifting from office to outpatient settings, HCCI finds
With that comes higher costs, Health Care Cost Institute researchers found. For example, the average price for a level 3 diagnostic and screening ultrasound grew 4% for office visits versus 14% in outpatient settings.
By Les Masterson • April 3, 2019
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