Payer: Page 96
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Legacy systems, employee error leave hospitals, devices vulnerable to cyberattacks
Improper handling and storage of patient files, often due to poor organizational policies and procedures, can give hackers the upper hand over healthcare organizations, according to new research from threat detection firm Vectra.
By Meg Bryant • April 26, 2019 -
ACA could cushion payers during next recession: Moody's
While health insurers wouldn't be able to avoid taking a hit from lower employment levels, the rating agency's research shows Medicaid expansions and the ACA exchanges create protections the companies didn't have in 2008.
By Tony Abraham • April 26, 2019 -
FTC accuses Surescripts of monopolizing e-prescribing markets
The commission alleges the health IT vendor, owned by some of the biggest PBMs and pharmacies, used exclusivity agreements and threats to stop customers from using other platforms.
By Shannon Muchmore • April 25, 2019 -
Humana, Doctor On Demand launch virtual primary care plan
The new plan, called On Hand, includes a dedicated primary care provider and low copays.
By Meg Bryant • April 25, 2019 -
CMS urges state Medicaid programs to test new dual eligible care models
The agency lamented the lack of care coordination for the dual eligible population that leads to "misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all."
By Les Masterson • April 25, 2019 -
Hospitals, doctors and Gawande laud new CMS primary care model, but will practices stay?
The agency set an ambitious goal of enrolling a quarter of all traditional Medicare fee-for-service providers and beneficiaries in the new model. The program, however, is voluntary, and some paths carry significant downside risk.
By Shannon Muchmore • April 24, 2019 -
Membership increases drive Anthem's Q1 revenue growth above 9%
The insurance giant raised its earnings outlook for the full year but refrained from joining other payers weighing in on "Medicare for All."
By Samantha Liss • April 24, 2019 -
CMS details new primary care payment model with range of risk options
The agency projects as many as a quarter of traditional Medicare fee-for-service beneficiaries will be incorporated into the voluntary five-year program, called Primary Cares Initiative.
By Shannon Muchmore • April 23, 2019 -
Medicare spending to snowball to 6% of GDP in next 2 decades, trustees predict
It's "striking" how Congress has ignored the warning signs of runaway spending, Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy, told Healthcare Dive.
By Rebecca Pifer Parduhn • April 23, 2019 -
Centene's membership growth fuels Q1 as CEO updates divestiture plan
The payer upped its 2019 guidance after beating analyst expectations on revenue and earnings.
By Samantha Liss • April 23, 2019 -
Surprise billing, drug rebates among likely reforms this year, S&P Global says
ACA repeal efforts and "Medicare for All," however, have little chance of advancing in the current political landscape, according to a new report.
By Meg Bryant • April 22, 2019 -
CMS makes no change to silver loading, finalizes lower ACA exchange fees
The final rule for 2020 exchange plans also allows insurers to forgo applying drug manufacturer coupons toward patient out-of-pocket cost limits when a brand name drug has a generic alternative available.
By Shannon Muchmore • April 22, 2019 -
Fewer uninsured ED visits, hospitalizations after ACA, JAMA study finds
The report also credited recent trends like new payment models for the decrease, as well as growing hospital ED alternatives such as urgent care clinics, freestanding emergency rooms and telemedicine.
By Les Masterson • April 22, 2019 -
Physician telehealth use up 340% since 2015, survey finds
Among specialties with high burnout rates, willingness to use telehealth runs high but actual use is still low, according to the American Well report.
By Meg Bryant • April 17, 2019 -
Chronic illnesses will play even bigger role in healthcare in coming years
Conditions like diabetes, cardiovascular disease, arthritis, Alzheimer's disease, obesity and cancer cost more than $1 trillion annually.
By Les Masterson • April 17, 2019 -
Humana rolls out oncology payment model
Sixteen practices are participating in the inaugural test of the model, which began in January across 11 states.
By Rebecca Pifer Parduhn • April 17, 2019 -
UnitedHealth CEO's 'Medicare for All' bashing sends payer, provider shares tumbling
The biggest private payer beat Wall Street expectations on Tuesday, but a rebuke of plans to expand Medicare weighed on health companies.
By Samantha Liss • April 17, 2019 -
Nearly all states using value-based payment models
Researchers commissioned by health IT firm Change Healthcare found 34 states have initiatives that are two years or older. Just four states have no official value program: Georgia, Indiana, Mississippi and West Virginia.
By Shannon Muchmore • April 16, 2019 -
MA growth helps fuel UnitedHealth's 9% Q1 revenue bump
The payer raised its earnings expectations for the year, while also taking a shot at calls for movement toward a Medicare for all type insurance system.
By Samantha Liss • April 16, 2019 -
Primary care accounts for small fraction of Medicare spending
Primary care spending percentages were lower for more vulnerable beneficiaries and varied by state, according to a new report by RAND.
By Les Masterson • April 16, 2019 -
Sutter to pay $30M to settle Medicare Advantage overpayment allegations
An HHS OIG official said "large health systems can expect a thorough investigation of claimed enrollees' health status," as MA plans become more popular.
By Samantha Liss • April 15, 2019 -
GM exec calls for more pressure on consolidating healthcare companies
The healthcare leader for the car giant put Cigna on defense about whether the payer's combination with Express Scripts will result in lower costs.
By Samantha Liss • April 12, 2019 -
Healthcare again tops industries for cybersecurity attacks, data breaches
Breach notifications triggered 34 investigations by the HHS Office for Civil Rights in 2018, up from 22 the previous year.
By Meg Bryant • April 11, 2019 -
Digital care coordination software market to top $3B by 2022, but hurdles remain
Driving growth is poor referral management, a desire for real-time communication on patient outcomes and potential savings from improving chronic disease management, according to a report from Frost & Sullivan.
By Meg Bryant • April 11, 2019 -
Medicaid reimbursement, not expansion status, affects doctors' acceptance of new patients
The percentage of providers willing to take on new Medicaid patients also did not change based on a state's Medicaid managed care offerings, according to an analysis of MACPAC data.
By Les Masterson • April 11, 2019
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