Payer: Page 98
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1 in 7 patients get surprise bill after in-network hospital care, HCCI finds
Anesthesiologists had the highest percentage of out-of-network professional claims in an in-network hospitalization, followed by primary care and emergency services, according to the Health Care Cost Institute.
By Les Masterson • March 29, 2019 -
Centene, WellCare union likely to raise antitrust concerns
The two companies both serve Medicaid beneficiaries in the same nine states and have significant overlap in certain markets, the most problematic territories being Missouri, Nebraska and Georgia.
By Samantha Liss • March 29, 2019 -
Judge rules Trump AHP expansion unlawful 'end-run' around ACA
The decision included strong words condemning the rule allowing for easier creation and use of AHPs, calling the regulatory change a "magic trick" that allowed for "absurd results" undermining the intent of Congress.
By Shannon Muchmore • March 29, 2019 -
Wyden floats adding prescription drug comparison tool to EHRs
A preliminary outline from the top Democrat on the Senate Finance Committee lacks many specifics, such as potential ramifications on EHR usability or increased administrative burden on providers.
By Rebecca Pifer Parduhn • March 28, 2019 -
Killing ACA would lead to huge spikes in uncompensated care
Medicaid expansion states and those with large ACA plan enrollment would feel the most pain if the landmark law is repealed.
By Les Masterson • March 27, 2019 -
Deep Dive
Scale: blessing or burden for statewide ACOs?
Caravan Health launched its second statewide ACO last week. Some experts worry the scale of the models means Caravan is biting off more than it can chew.
By Rebecca Pifer Parduhn • March 27, 2019 -
Centene $17B WellCare buy will boost Medicare footprint
The deal would increase Centene's size with the addition of 5.5 million lives, though analysts caution overlap or concentration could be an antitrust issue in a few states.
By Samantha Liss • March 27, 2019 -
ACA exchange enrollment dips by 300K
The decline was less than predicted amid fears of an exodus after the financial penalty for the individual mandate was zeroed out.
By Samantha Liss • March 26, 2019 -
Trump admin now backs elimination of ACA in court
The move came hours after Democratic attorneys general defending the ACA filed their brief arguing that the landmark law is still constitutional even without an effective individual mandate penalty.
By Shannon Muchmore • Updated March 26, 2019 -
Incentivizing healthy eating could have big payoff for Medicaid, Medicare
Providing adults on the government programs a 30% subsidy on fruits and vegetables would prevent nearly 2 million cardiovascular events, according to a study in PLOS Medicine.
By Meg Bryant • March 25, 2019 -
Deep Dive
Private equity sees ripe opportunity in healthcare this year
Attractive targets include orthopaedics, gastroenterology and urology practices and mental health and addiction services.
By Samantha Liss • March 25, 2019 -
Payer participation in ACA exchanges lacks in parts of US
In the Northeast, 40% of the population lives in an area with at least five ACA plan payers. That figure is only 4% in the South, according to the Urban Institute.
By Les Masterson • March 22, 2019 -
GAO finds 'small number' of payers dominate private, ACA markets
The three largest payers in most states owned 80% or more of the private market in 2016, with even more concentration in state ACA exchanges up to 2017, the watchdog agency said.
By Tony Abraham • March 22, 2019 -
MIPS participation in year 1 nets 95% of eligible clinicians
Of those participating in the Merit-based Incentive Payment System in 2017, 93% earned a positive payment adjustment, according to a new CMS report.
By Meg Bryant • March 21, 2019 -
Nearly 70% of air ambulance transports in 2017 put patients at risk of balance bills, GAO says
Air ambulance providers and insurers admit the share of out-of-network transports are high, but said they've recently entered into more in-network deals.
By Samantha Liss • March 21, 2019 -
Opinion
Oscar Health: a rebel brand without a cause
Daniel Black from brand strategy consultancy Vivaldi on why 7-year-old payer Oscar Health is all flash and little substance.
By Daniel Black • March 21, 2019 -
Sage's postpartum depression drug is approved. Now comes the hard part
Zulresso's label requires women to undergo a 60-hour infusion and only in certain settings, factors that may hamper the drug commercially.
By Jacob Bell • Updated March 20, 2019 -
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 Parduhn • 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 Parduhn • March 20, 2019 -
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 Parduhn • March 18, 2019
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