Payer: Page 94
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Centene and its PBM partner promise disruption, but analysts are skeptical
The payer is parting ways with CVS, shifting its PBM business to a relatively new competitor in RxAdvance.
By Samantha Liss • March 7, 2019 -
Free-standing ERs costs 22 times more than doctor's office, UnitedHealth study says
There were at least 566 free-standing ERs in the country in 2016, which was a 42% increase from the previous year and a 155% increase from 2008, according to a UnitedHealth Group report.
By Les Masterson • March 7, 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 -
CMS wants to make selling out-of-state insurance easier
Selling insurance across state lines is a policy idea long-championed by conservatives, but hardly adopted in part as it comes with a bevy of consumer protection and antitrust hangups.
By Tony Abraham • March 7, 2019 -
Montgomery County Planning Commission
The CIO's role in M&A: CVS, Aetna undergo integration
While Aetna will operate as a standalone company under CVS Health, eliminating redundancies and merging best practices.
By Naomi Eide • March 7, 2019 -
Why 2019 could be 'last easy year' for payers
Major U.S. insurers reported mostly positive quarterly and year-end financial results in the first months of this year, but political pressure and continued provider consolidation loom ahead.
By Shannon Muchmore • March 6, 2019 -
Amazon-JPM-Berkshire Hathaway troika has a name: Haven
Few concrete details emerged from the branding bid, but Haven's website and a letter from CEO Atul Gawande set lofty guiding principles for the venture.
By Rebecca Pifer • March 6, 2019 -
Rural areas hit hardest on unsubsidized ACA plans
In about one in five U.S. counties, a 40-year-old making $50,000 a year spends more than 10% of their income on the cheapest ACA plan, according to the Kaiser Family Foundation.
By Les Masterson • March 6, 2019 -
Judge rules against UnitedHealth behavioral unit over claims denials
Plaintiffs alleged they were wrongfully denied care for mental health services. A judge said the company put financial motives above clinical decisions.
By Samantha Liss • March 6, 2019 -
Paying patients to shop yields modest savings, Health Affairs study finds
Price reductions were mostly seen in imaging services, especially MRI and ultrasound.
By Meg Bryant • March 5, 2019 -
Medicare for all (or some), buy in and other universal plans vary widely
Democratic presidential candidates like Sens. Kamala Harris and Bernie Sanders support a single-payer system. Sen. Amy Klobuchar backs a more modest Medicaid buy-in proposal.
By Les Masterson • March 5, 2019 -
US kidney care getting revamp, HHS officials say
Stocks of multiple dialysis providers plummeted Monday as Trump administration health chiefs previewed changes to kidney care payment models and transplant procedures.
By Rebecca Pifer • March 4, 2019 -
Cost major influence in choosing medical care, survey shows
Despite that concern and rising out-of-pocket costs, more than two-thirds of adults don't seek cost estimates before getting care, a VisitPay survey found.
By Meg Bryant • Feb. 28, 2019 -
Courtesy of Sanofi
Sanofi handed payers nearly $12B in drug rebates last year
That's why, despite increasing the U.S. list price on 35 of its 76 prescription drugs, the French pharma reported an average net price decline of 8% in 2018.
By Ned Pagliarulo • Feb. 27, 2019 -
ACA plans denied nearly 1 in 5 in-network claims in 2017
Fewer than 1% of those denials were appealed, according to an analysis from the Kaiser Family Foundation.
By Les Masterson • Feb. 27, 2019 -
Doctor On Demand rolls out virtual care platform for primary care
The telehealth vendor is targeting its Synapse platform at health plans and employers.
By Meg Bryant • Feb. 26, 2019 -
Partial Medicaid expansion would increase uninsured rate, federal costs
A few states that haven't expanded the program under the ACA, including Utah and Georgia, are looking at partial expansion plans in an attempt to cut costs.
By Les Masterson • Feb. 22, 2019 -
UPMC fires back at state AG, seeks to join BCBS antitrust lawsuit
The flurry of filings taps into big questions over payer competition and underscores tensions between insurance companies and providers as they negotiate contracts, especially in highly concentrated markets.
By Tony Abraham , Samantha Liss • Updated March 19, 2019 -
Hospitals oppose fixed payments in any laws tackling surprise billing
Meanwhile, a new analysis shows that about one in five emergency department visits involve an out-of-network provider and could result in a surprise bill.
By Shannon Muchmore • Feb. 21, 2019 -
US healthcare spending growth to hit 5.5% by 2027, CMS predicts
The ballooning American healthcare bill will outstrip growth of the GDP over the next decade, according to an annual government report.
By Rebecca Pifer • Feb. 20, 2019 -
Seniors love Medicare, but are pessimistic about its long-term future
One-third of responders to eHealth's Medicare Consumer Survey said when choosing a plan, an affordable monthly premium is the most important consideration.
By Les Masterson • Feb. 20, 2019 -
CMS unveils CAR-T proposal, with emphasis on patient outcomes
High price tags and a potential one-time administration have challenged CMS to figure out reimbursement for CAR-T cell therapies.
By Jacob Bell • Feb. 20, 2019 -
CVS 2019 guidance disappoints amid major headwinds
In its first earnings since bringing Aetna into the fold, the drugstore chain cited pressures having a "disproportionate impact" on the year, including issues with its long-term care business.
By Samantha Liss • Feb. 20, 2019 -
Insurers owed CSR payments regardless of silver loading, judges rule
In one of the lawsuits, a judge wrote the payer "should not be left 'holding the bag' for taking our Government at its word."
By Shannon Muchmore • Feb. 19, 2019 -
DOJ sticking with CVS-Aetna merger pact despite negative public comments
The agreement, which required Aetna to divest all of its Medicare Part D business, "fully addresses the competitive threat posed by the merger," the department said.
By Samantha Liss • Feb. 19, 2019 -
CMS emergency transport model supports telehealth, non-hospital venues
The five-year demonstration project — scheduled to kick off early next year — also encourages the creation of medical triage lines for low-acuity 911 calls.
By Meg Bryant • Feb. 15, 2019
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