Payer: Page 95
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Charitable enough? UPMC case highlights increased scrutiny of nonprofit hospitals
"I think the bottom line is: The AG is not going to be satisfied with a duopoly in which one firm is clearly dominant and is going to be able to have its way," said Tim Greaney, former assistant chief in the DOJ's antitrust division.
By Tony Abraham , Samantha Liss • Feb. 15, 2019 -
Partners-CNE deal won't get thorough review in Massachusetts
The state's health policy commission reported Partners' acquisition of Care New England will not affect competition or set back care access because of the health systems' different patient populations and geographies.
By Les Masterson • Feb. 15, 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 -
HIMSS19: Lyft looks at nutrition amid population health focus
The strategy would expand the car-hailing firm's focus on addressing social determinants of health.
By Rebecca Pifer • Feb. 15, 2019 -
Deep Dive
4 main takeaways from HIMSS19
Digest the biggest health IT conference of the year with this roundup of what grabbed the attention of more than 43,000 health execs, policymakers and academics.
By David Lim , Rebecca Pifer • Feb. 15, 2019 -
Accrediting group updates widely used quality metrics
Medicare Advantage plans use NCQA quality metrics to measure the performance within their provider networks, any changes to those measures will be closely watched as MA plans now cover 22.4 million seniors.
By Meg Bryant • Feb. 14, 2019 -
Payers divided over best value-based payment model, survey finds
The new HealthEdge survey found that more than half of respondents believe provider and member engagement are the biggest obstacles to implementing value-based contracts.
By Les Masterson • Feb. 14, 2019 -
Data breaches compromised 15.1M patient records last year
The number of affected records was up sharply from the year before, when nearly 500 breaches affected 5.6 million records, according to Protenus.
By Meg Bryant • Feb. 13, 2019 -
HIMSS19: CVS, Cigna execs tout pharmacies amid pricing debate
The PBM leaders made the pitch they are well-placed to help drive down costs, given patients interact far more often with pharmacists than other healthcare providers.
By Rebecca Pifer • Feb. 13, 2019 -
Mid-sized hospitals could recover $500K through finding dual-eligibles
Medicaid is a "significant source of untapped reimbursements," according to a new report from TransUnion Healthcare.
By Les Masterson • Feb. 13, 2019 -
Provider groups wary of major changes to HIPAA
In response to an HHS request for information, AHA, AMA and others urged maintaining the status quo when it comes to potential amendments to the privacy law to better accommodate for value-based payment models.
By Shannon Muchmore • Feb. 13, 2019 -
Elizabeth Regan/Healthcare Dive
Regeneron, Sanofi cut PCSK9 list price, matching earlier move by rival Amgen
The drugmakers will soon make Praluent available for 60% less than the cholesterol drug's original price, a rare move reflective of ongoing commercial challenges.
By Ned Pagliarulo • Feb. 13, 2019 -
Molina saw membership drop in 2018, but net income rose substantially
Analysts characterized the better-than-expected results as "eye-popping."
By Samantha Liss • Feb. 12, 2019 -
Prices — not use — drive higher healthcare costs, HCCI says
Inpatient utilization dropped, but higher prices increased inpatient spending by 10% between 2013 and 2017. Meanwhile, outpatient surgery prices and higher emergency room use and prices led to more outpatient costs.
By Les Masterson • Feb. 12, 2019 -
Hospitals should focus on productivity gains to reduce costs, report finds
From 2001 to 2016, the healthcare delivery industry grew 3.3% annually to $1.3 trillion — with 99% of growth fueled by labor costs, according to McKinsey & Company.
By Meg Bryant • Feb. 11, 2019 -
Republicans eye modest Medicaid expansion
The safety net program is growing in popularity, leaving some GOP politicians to juggle the pros and cons of expanding it to more low-income Americans.
By Les Masterson • Feb. 10, 2019 -
EDs could save $8.3B annually with better primary care, study finds
Of 24 million emergency visits by patients with certain chronic conditions in 2017, 4.3 million were potentially avoidable, according to a Premier analysis.
By Meg Bryant • Feb. 8, 2019 -
Lyft eyes bigger role in nonemergency medical transport, MA plans
The rideshare giant is upgrading its Concierge product and starting collaborations with Blue Cross Blue Shield Institute and LogistiCare to reach more Medicare Advantage members.
By Meg Bryant • Feb. 8, 2019 -
Deep Dive
Hospital lobby ramps up 'Medicare for all' opposition
As more Democratic presidential hopefuls embrace the idea, health systems and providers have picked up lobbying efforts arguing it would shutter hospitals.
By Tony Abraham • Feb. 8, 2019 -
Health information exchange participation reduced readmissions in heart attack patients, study finds
The Florida report suggests HIEs could be deployed to enhance quality measures in the Hospital Readmissions Reduction Program.
By Meg Bryant • Feb. 7, 2019 -
EHR vendor Greenway Health hit with $57.25M False Claims fine
In addition to misrepresenting the capabilities of its software, the company is accused of falsely obtaining 2014 Edition certification status for its Prime Suite EHR.
By Meg Bryant • Feb. 7, 2019 -
Judge denies Oscar injunction over exclusive broker policies in Florida
The startup insurer alleged that it failed to capture projected market share in the state because of brokers lost due to exclusive contracts enforced by its competitor — Blue Cross Blue Shield of Florida.
By Samantha Liss • Feb. 7, 2019 -
Deep Dive
With CMS depression device on the line, analysts eye multibillion potential market
The government insurer may cover a clinical trial of LivaNova's vagus nerve stimulation in some cases as a last resort for severe depression. At the same time, some patients are turning to less invasive tech-driven therapies.
By Maria Rachal • Feb. 7, 2019 -
Employer plans contributed most to growth in underinsured
Long-term uninsured rates have also dropped, from 72% of people going without coverage for more than two years in 2010 to 54% in 2018, according to a new report from The Commonwealth Fund.
By Shannon Muchmore • Feb. 7, 2019 -
Anthem members sue payer for inadequate notice of dropped providers
The insurance giant has agreed to delay considering Atlanta-based health system WellStar's primary care providers out-of-network until May after a request from the Georgia Department of Insurance.
By Les Masterson • Updated March 6, 2019 -
Docs say prior authorizations harm clinical outcomes
Nearly two-thirds of physicians said they wait at least one business day for prior authorization decisions from health plans, according to the report from the American Medical Association.
By Meg Bryant • Feb. 6, 2019
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