Payer: Page 93
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Specialty drug costs skyrocketed to $32.8B in Medicare Part D in 2015
Brand-name specialty drugs accounted for only 1% of all prescriptions dispensed in both Medicare Part D and Medicaid, but made up about 30% of net spend.
By Rebecca Pifer • March 20, 2019 -
Electronic prior authorization merits wider adoption, health IT, payer groups say
New data show the practice led to faster turnaround times and higher dispense rates than traditional requests by phone or fax.
By Rebecca Pifer • March 20, 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 -
Managing high-cost claims tops employer benefit plan concerns
Companies are also offering their workers more perks like telehealth, according to a new Mercer cost trends survey.
By Meg Bryant • March 19, 2019 -
Payers, employers pitch fixed reimbursement rates for out-of-network providers to curb surprise billing
Hospital groups quickly slammed the proposal as "a dangerous precedent" that could "create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks."
By Les Masterson • March 19, 2019 -
Physician-led ACOs leaving Medicare program in greater numbers
The vast majority of ACOs have stayed with the Medicare Shared Savings Program, however, with only 13% of them dropping out last year.
By Les Masterson • March 18, 2019 -
Direct enrollment for ACA plans may lead to higher costs, fewer protections
The Center on Budget and Policy Priorities warned that direct enrollment through entities other than HealthCare.gov or state exchange websites stifles competition and can confuse and mislead consumers.
By Les Masterson • March 18, 2019 -
Healthcare execs worried about business model disruption, survey shows
Risk aversion, integrating social determinants of health and rising consumerism are also catching the attention of C-suites in 2019, according to a new survey commissioned by Change Healthcare and the HealthCare Executive Group.
By Meg Bryant • March 18, 2019 -
Short-term plans, Medicaid waivers, MA benefits dominate AHIP conferences
A House panel is investigating short-term "junk plans" and payers look to take advantage of more flexible benefit options in Medicare Advantage. That (and more) from AHIP's dual conferences last week.
By Shannon Muchmore , Rebecca Pifer • March 18, 2019 -
Amazon-Berkshire-JPM's Haven hires clinical strategy leader
Sandhya Rao joins the splashy venture from Partners Population Health, where she was senior medical director.
By Meg Bryant • March 15, 2019 -
Medicaid work requirements will hurt hospital finances
Meanwhile, this week Trump administration officials argued in defense of the work requirements in front a skeptical federal judge who already halted the regulation in Kentucky.
By Les Masterson • March 15, 2019 -
Telehealth underused by federally qualified health centers, analysis finds
Centers use telehealth largely for behavioral health sessions with patients, though some store-and-forward activities and remote patient monitoring also occur, according to the report by RAND Corporation.
By Meg Bryant • March 14, 2019 -
State-run reinsurance programs helped lower ACA plan premiums by 20%
The seven states using reinsurance have saved the federal government almost $1 billion, according to a new report from Avalere.
By Les Masterson • March 14, 2019 -
Blues challenge UPMC, call Highmark contract dispute 'of its own making'
The Blue Cross Blue Shield Association argued it's too late for UPMC to intervene in a years-long litigation challenging the way Blues plans operate.
By Samantha Liss • Updated March 15, 2019 -
PBMs called to give patients 'an explanation' by Senate panel
Cigna, CVS Caremark and CVS Health, Humana, UnitedHealth's OptumRx and Prime Therapeutics got invites to the latest Senate Finance Committee hearing. The panel said two of the companies have so far agreed to testify.
By Shannon Muchmore • Updated March 19, 2019 -
AMA says prior authorizations increasing, interfering with care continuity
A new survey of 1,000 physicians found that more than two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization.
By Les Masterson • March 13, 2019 -
Cambia, BCBS of North Carolina link to form $16B insurer
The entity will remain under the Cambia name and be helmed by current Blue Cross North Carolina head Patrick Conway, who formerly led the Center for Medicare and Medicaid Innovation.
By Rebecca Pifer • March 13, 2019 -
House panel to launch investigation into short-term 'junk' plans
The Committee on Energy and Commerce will probe companies offering the short-term coverage and "hold them accountable," said Chairman Frank Pallone, D-N.J., including those run by UnitedHealth and Anthem.
By Rebecca Pifer • March 13, 2019 -
HHS hints at cutting 'onerous' substance abuse record rules
Deputy Secretary Eric Hargan told attendees at AHIP's National Health Policy Conference to "watch this space very carefully" for changes to the law known as Part 2.
By Rebecca Pifer • March 13, 2019 -
Hospital groups say public option would cut payments by 10%
The American Hospital Association and Federation of American Hospitals argue an opt-in government insurance plan would hit bottom lines and disrupt the insurance market.
By Tony Abraham • March 13, 2019 -
Healthcare prices rose but use fell across US from 2012-16
Metro areas along the coast tended to have higher prices than in the Midwest, but there were many examples of neighboring areas with "starkly different" price levels, according to the Health Care Cost Institute.
By Meg Bryant • March 12, 2019 -
Trump admin proposes massive cuts to Medicaid, Medicare
Nearly all items on the wishlist hold zero chance of becoming law, but will likely give Republicans a headache come election time.
By Rebecca Pifer • March 12, 2019 -
Population health program growth sputters, though execs agree they're needed
The potential of losing money in risk-based contracts is the most significant reason health systems are resistant to move into value-based care, according to a new Numerof & Associates report.
By Les Masterson • March 12, 2019 -
Pharmas, PBMs and payers all take a slice along drug supply chain, Pew says
As pharmaceutical spending and PBMs take fire in Washington, the report aims to suss out the players pocketing a share as drugs make their way through the system.
By Les Masterson • March 11, 2019 -
MedPAC eyes changes to ED coding, Part B drug pricing
Meanwhile, MACPAC discussed how shortfalls should be counted for Medicaid patients with third-party coverage in the DSH program.
By Les Masterson • March 11, 2019 -
Nashville program looks to tackle uncompensated care costs
The plan comes two years after then-Mayor Megan Barry proposed closing Nashville General as an inpatient facility. About 15% of the city's residents are uninsured or underinsured.
By Les Masterson • March 8, 2019
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