Payer: Page 97
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Texas Blue, Sanitas USA to open 10 primary care clinics in Dallas, Houston
Services at the new "one-stop medical centers" will be available to Blue Cross and Blue Shield cardholders, along with self-pay patients and Medicare fee-for-service beneficiaries.
By Rebecca Pifer Parduhn • April 10, 2019 -
PBMs escape Senate hearing largely unscathed
Testifying before the Senate Finance Committee on Tuesday, executives from Cigna, CVS Caremark and other PBMs stuck to their familiar tune of blaming manufacturer list prices for fueling skyrocketing prices.
By Samantha Liss • April 10, 2019 -
UnitedHealthcare expands MA bundled payment plan offerings for 2020
The payer estimates it will have $75 billion in annual provider reimbursements tied to value-based arrangements by the end of next year.
By Rebecca Pifer Parduhn • April 10, 2019 -
Most hospitals provide electronic access to records, but patients slow to engage, ONC says
More than half of U.S. hospitals enabled patients to electronically request prescription refills in 2017 — up from just over a quarter in 2013, according to a new report.
By Meg Bryant • April 9, 2019 -
Healthcare administrative costs will tally nearly $500B this year
The price tag includes $158 billion in private insurance overhead, $56 billion for public insurance program administration and $282 billion for providers' billing and insurance-related costs, according to the Center for American Progress.
By Rebecca Pifer Parduhn • April 9, 2019 -
Emergency department visits rose, but misuse fell in 2016
Wait times improved, according to the CDC data. Nearly 40% of patients had wait times of less than 15 minutes and 72% waited less than an hour.
By Les Masterson • April 8, 2019 -
CMS gives MA plans telehealth boost with expanded benefits
Building on recently finalized policies to expand supplemental benefits, the rule also seeks to update star ratings methodology and improve the appeals process for dual eligible beneficiaries.
By Tony Abraham • April 8, 2019 -
340B program leads to higher costs, PhRMA-commissioned report finds
The research conducted by Berkeley Research Group is the latest skirmish in a battle over the program, which health systems argue helps safety net hospitals access affordable prescription drugs.
By Les Masterson • April 8, 2019 -
MedPAC wants to redesign MA quality bonus program
The advisory commission also voted Thursday to recommend Congress pass legislation to withhold some Medicare Advantage plan payments if an insurer's encounter data is wrong or incomplete.
By Rebecca Pifer Parduhn • April 5, 2019 -
CVS-Aetna judge to hear testimony from critics next month
The American Medical Association is expected to be among the witnesses called as the federal judge tasked with approving the merger agreement between the companies and the DOJ drags out his review.
By Samantha Liss • Updated April 23, 2019 -
PBM group says HHS drug rebate proposal would increase costs more than predicted
However, Fitch Ratings said in a new forecast it doesn't expect the change will have a long-term impact on margins or profits for payers, drug companies or distributors.
By Les Masterson • April 5, 2019 -
Amazon's Alexa now has HIPAA-compliant features
Six companies taking part in the online giant's invitation-only developer program launched their features Thursday, including Atrium Health, Cigna, Express Scripts and Livongo.
By Shannon Muchmore • April 4, 2019 -
Alex Wong via Getty Images
CMS approves Maine's long-awaited Medicaid expansion
The state's voters approved expansion in November 2017 for implementation no later than July 2018. However, then-governor Paul LePage, a Republican, refused to carry out the measure last year.
By Rebecca Pifer Parduhn • April 4, 2019 -
Medicaid expansion improves community health center finances, access to care
Centers in the three dozen expansion states are more likely to offer behavioral health counseling and coordinated care than non-expansion states, according to The Commonwealth Fund.
By Les Masterson • April 4, 2019 -
Industry groups seek cybersecurity safe harbor
In response to a senator's request, several organizations highlighted the need for a national strategy and greater collaboration among various stakeholders, according to a think tank that read the responses.
By Meg Bryant • April 3, 2019 -
Americans' healthcare paradox: 'angst' on costs, overconfidence on quality
Nearly 70% of Americans are "not at all" confident that politicians will be able to pass legislation to lower healthcare costs, according to a new West Health and Gallup survey.
By Rebecca Pifer Parduhn • April 3, 2019 -
More care shifting from office to outpatient settings, HCCI finds
With that comes higher costs, Health Care Cost Institute researchers found. For example, the average price for a level 3 diagnostic and screening ultrasound grew 4% for office visits versus 14% in outpatient settings.
By Les Masterson • April 3, 2019 -
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 -
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
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