Payer: Page 91
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Hospitals saved $1K per episode under joint replacement bundled model
Most participating hospitals received reconciliation payments in at least one of the program's first two years. Those getting the bonus tended to have higher quality scores, more episodes of care and lower patient complexity.
By Shannon Muchmore • July 1, 2019 -
ACA insurers remain profitable despite policy changes
"Earlier concerns that the market would collapse or insurer exits would lead to counties with no coverage available at all have proven unfounded," according to a new Kaiser Family Foundation report.
By Samantha Liss • July 1, 2019 -
Aiming for price transparency, Civica Rx hits snag with bundled payments
The payment model, often opaque on specific drug costs, affects many of the medicines the hospital-led group is targeting, according to commercial chief Heather Wall.
By Jacob Bell • June 27, 2019 -
CMS clears Louisiana Medicaid 'Netflix model' for hep C drugs
The subscription model will go into effect Monday, coming after the state inked a five-year partnership with a Gilead subsidiary to manufacture the treatment.
By Rebecca Pifer Parduhn • June 26, 2019 -
MA patients' readmission rates higher than traditional Medicare, study finds
A study in the Annals of Internal Medicine adds to a growing body of research analyzing the Medicare Hospital Readmission Reduction Program's effect on patient outcomes.
By Linda Wilson • June 26, 2019 -
Samsung Bioepis CEO urges patience as US biosimilar market lags
"Market shaping takes time," the head of the Korean drugmaker said, as a few experts propose giving up on the copycat biologics altogether.
By Ned Pagliarulo • June 26, 2019 -
Majority of patients faced out-of-pocket expense of $500 or more last year
Out-of-pocket costs are increasing even as patients shift to less expensive care settings, according to a new report from TransUnion Healthcare.
By Samantha Liss • June 26, 2019 -
Deep Dive
Hospital price transparency push draws industry ire, but effects likely limited
While few would argue for secrecy for its own sake, policy analysts say there's little evidence patients use the information now available to make decisions that could bend the cost curve.
By Shannon Muchmore • June 25, 2019 -
Shareholders overwhelmingly approve Centene-WellCare union
This isn't the final hurdle for the $17 billion deal, which still awaits approval from more than 20 states.
By Samantha Liss • Updated June 25, 2019 -
UPMC, Highmark ink 10-year contract after years of fighting
The reconciliation comes less than a week before a deadline that would cut off Highmark-insured patients from access to many UPMC facilities.
By Rebecca Pifer Parduhn • June 25, 2019 -
Supreme Court to hear $12B risk corridor case next term
The Chamber of Commerce urged the court to take the case, warning that if the government is allowed to renege on its promised payments it could scare off the business community from working with the government.
By Dana Elfin • June 25, 2019 -
CVS, government urge federal judge to bless settlement pact
Attorneys general from five states reaffirmed their support this week of the Justice Department's settlement with CVS over its acquisition of Aetna. Oral argument is set for later this month.
By Dana Elfin • Updated July 2, 2019 -
Trump order to force hospitals to reveal information behind negotiated rates
Providers and payers will be required to give patients estimates for out-of-pockets costs for procedures in advance under an executive order the president is expected to sign Monday. A legal challenge is likely.
By Shannon Muchmore • June 24, 2019 -
AHIP19: Insurers acknowledge heightened cost pressures
"We really do have to tackle head on the issue of affordability," Matt Eyles, CEO of AHIP, said during the lobby's annual conference.
By Samantha Liss • June 24, 2019 -
Not 'a build it and they will come kind of thing': Telehealth descends on AHIP19
Doctor on Demand and Teladoc were among the telehealth players that descended on the insurance industry's annual meeting to tout services aimed at helping payers bend the cost curve.
By Kim Dixon • June 21, 2019 -
Surprise billing fixes would ding hospitals, staffing companies, Moody's says
Legislative proposals to end the practice of surprise billing are mostly credit negative for providers, but fixes that include bundled billing or an in-network guarantee would have the worst effect.
By Rebecca Pifer Parduhn • June 21, 2019 -
Social determinants of health the buzzword at AHIP19
A new initiative aims to bring together payers from different markets and geographies to work together on establishing programs to combat social inequities that negatively affect health.
By Samantha Liss • June 21, 2019 -
UnitedHealth's acquisition of DaVita physician group gets FTC approval
Under an agreement reached with the federal agency, the payer will divest the medical group's Las Vegas practice to Intermountain Healthcare.
By Shannon Muchmore • June 20, 2019 -
At AHIP19, a call to 'break glass' to survive fast-changing industry
Panelists at AHIP, including former CVS head Andy Slavitt, called for disruption across healthcare, including increasing partnerships among providers, payers and home health companies.
By Kim Dixon • June 20, 2019 -
Public option, increased premium credits could save $12B
Such changes would also provide coverage for an additional 1.2 million people, according to a report from the Urban Institute.
By Shannon Muchmore • June 19, 2019 -
Providers ready to take on more risk, survey shows
A Navigant survey of 170 hospital and healthcare system senior finance executives shows 72% plan to take on additional risk over the next one to three years.
By Dana Elfin • June 19, 2019 -
AHIP19: Cigna CEO says 'society demands more' from industry
David Cordani addressed consumer frustration and the industry's need to improve, especially when it comes to curbing costs, opening the payer group's annual conference.
By Samantha Liss • June 19, 2019 -
CMS proposes rule to set Part D electronic prior authorization standards
Under the standard, providers can use an electronic prescribing system or EHRs to determine whether a plan requires prior authorization for the medication being prescribed and submit the information in real time.
By Shannon Muchmore • June 18, 2019 -
Getty / Edited by BioPharma Dive
Gene therapy costs, manufacturing keeping FDA biotech head 'up at night'
"When the cost of goods are very high, they help justify when people charge astronomical prices," said FDA's Peter Marks. "If we can help see cost of goods and ability to manufacture reproducibly improve, I think that'll be a big thing."
By Andrew Dunn • June 18, 2019 -
Trump admin opens door to fundamental changes in healthcare benefits
Paul Fronstin of the Employee Benefit Research Institute said he doesn't expect a ton of uptick right away, but when the next recession hits, "the future of health benefits gets put to the test."
By Samantha Liss • June 17, 2019
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