Payer: Page 92
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Cigna, Express Scripts promise to cap out-of-pocket insulin costs
Insulin manufacturers and PBMs have faced mounting pressure amid outrage over the rising cost of insulin, a nearly century old lifesaving drug.
By Samantha Liss • April 3, 2019 -
UnitedHealthcare, AMA team up on billing codes for social determinants
The two entities are developing 23 ICD-10 codes that could help address patients' socioeconomic needs by connecting them to relevant resources and social services.
By Tony Abraham • April 3, 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 -
Premium rates increasing faster than incomes for most in US
In some states, people are spending more than one-third of their income on health insurance costs, according to a report from the Leonard Davis Institute of Health Economics and United States of Care.
By Les Masterson • April 2, 2019 -
Growth in telehealth use outpaces urgent care centers, retail clinics
Between 2016 and 2017, telehealth use jumped 53% nationwide, according to a new white paper from the nonprofit FAIR Health.
By Meg Bryant • April 2, 2019 -
CMS finalizes nontraditional MA benefits, use of encounter data
The agency is allowing MA plans to cover expenditures associated with social determinants of health, such as covering the cost of fresh produce for beneficiaries with heart disease or carpet cleaning for people with asthma.
By Tony Abraham • Updated April 3, 2019 -
Academic medical centers face headwinds in shift to value-based care, Moody's says
To offset challenges, AMCs will need to consider partnerships that build out community physician networks and diversifying their revenue streams, according to a new report.
By Meg Bryant • April 1, 2019 -
Utah's partial Medicaid expansion cleared by CMS, sidestepping voters
The partial plan also includes work requirements, coming days after a federal judge knocked down similar mandates in Kentucky and Arkansas.
By Les Masterson • April 1, 2019 -
Employers overwhelmingly support ACA's pre-existing condition protections
The results come as the Trump administration's Department of Justice wants the courts to kill the landmark health law and its popular protections and essential benefits.
By Les Masterson • April 1, 2019 -
1 in 7 patients get surprise bill after in-network hospital care, HCCI finds
Anesthesiologists had the highest percentage of out-of-network professional claims in an in-network hospitalization, followed by primary care and emergency services, according to the Health Care Cost Institute.
By Les Masterson • March 29, 2019 -
Centene, WellCare union likely to raise antitrust concerns
The two companies both serve Medicaid beneficiaries in the same nine states and have significant overlap in certain markets, the most problematic territories being Missouri, Nebraska and Georgia.
By Samantha Liss • March 29, 2019 -
Judge rules Trump AHP expansion unlawful 'end-run' around ACA
The decision included strong words condemning the rule allowing for easier creation and use of AHPs, calling the regulatory change a "magic trick" that allowed for "absurd results" undermining the intent of Congress.
By Shannon Muchmore • March 29, 2019 -
Wyden floats adding prescription drug comparison tool to EHRs
A preliminary outline from the top Democrat on the Senate Finance Committee lacks many specifics, such as potential ramifications on EHR usability or increased administrative burden on providers.
By Rebecca Pifer • March 28, 2019 -
Killing ACA would lead to huge spikes in uncompensated care
Medicaid expansion states and those with large ACA plan enrollment would feel the most pain if the landmark law is repealed.
By Les Masterson • March 27, 2019 -
Deep Dive
Scale: blessing or burden for statewide ACOs?
Caravan Health launched its second statewide ACO last week. Some experts worry the scale of the models means Caravan is biting off more than it can chew.
By Rebecca Pifer • March 27, 2019 -
Centene $17B WellCare buy will boost Medicare footprint
The deal would increase Centene's size with the addition of 5.5 million lives, though analysts caution overlap or concentration could be an antitrust issue in a few states.
By Samantha Liss • March 27, 2019 -
ACA exchange enrollment dips by 300K
The decline was less than predicted amid fears of an exodus after the financial penalty for the individual mandate was zeroed out.
By Samantha Liss • March 26, 2019 -
Trump admin now backs elimination of ACA in court
The move came hours after Democratic attorneys general defending the ACA filed their brief arguing that the landmark law is still constitutional even without an effective individual mandate penalty.
By Shannon Muchmore • Updated March 26, 2019 -
Incentivizing healthy eating could have big payoff for Medicaid, Medicare
Providing adults on the government programs a 30% subsidy on fruits and vegetables would prevent nearly 2 million cardiovascular events, according to a study in PLOS Medicine.
By Meg Bryant • March 25, 2019 -
Deep Dive
Private equity sees ripe opportunity in healthcare this year
Attractive targets include orthopaedics, gastroenterology and urology practices and mental health and addiction services.
By Samantha Liss • March 25, 2019 -
Payer participation in ACA exchanges lacks in parts of US
In the Northeast, 40% of the population lives in an area with at least five ACA plan payers. That figure is only 4% in the South, according to the Urban Institute.
By Les Masterson • March 22, 2019 -
GAO finds 'small number' of payers dominate private, ACA markets
The three largest payers in most states owned 80% or more of the private market in 2016, with even more concentration in state ACA exchanges up to 2017, the watchdog agency said.
By Tony Abraham • March 22, 2019 -
MIPS participation in year 1 nets 95% of eligible clinicians
Of those participating in the Merit-based Incentive Payment System in 2017, 93% earned a positive payment adjustment, according to a new CMS report.
By Meg Bryant • March 21, 2019 -
Nearly 70% of air ambulance transports in 2017 put patients at risk of balance bills, GAO says
Air ambulance providers and insurers admit the share of out-of-network transports are high, but said they've recently entered into more in-network deals.
By Samantha Liss • March 21, 2019 -
Opinion
Oscar Health: a rebel brand without a cause
Daniel Black from brand strategy consultancy Vivaldi on why 7-year-old payer Oscar Health is all flash and little substance.
By Daniel Black • March 21, 2019 -
Sage's postpartum depression drug is approved. Now comes the hard part
Zulresso's label requires women to undergo a 60-hour infusion and only in certain settings, factors that may hamper the drug commercially.
By Jacob Bell • Updated March 20, 2019
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