Payer: Page 99
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Amazon-Berkshire-JPM's Haven hires clinical strategy leader
Sandhya Rao joins the splashy venture from Partners Population Health, where she was senior medical director.
By Meg Bryant • March 15, 2019 -
Medicaid work requirements will hurt hospital finances
Meanwhile, this week Trump administration officials argued in defense of the work requirements in front a skeptical federal judge who already halted the regulation in Kentucky.
By Les Masterson • March 15, 2019 -
Telehealth underused by federally qualified health centers, analysis finds
Centers use telehealth largely for behavioral health sessions with patients, though some store-and-forward activities and remote patient monitoring also occur, according to the report by RAND Corporation.
By Meg Bryant • March 14, 2019 -
State-run reinsurance programs helped lower ACA plan premiums by 20%
The seven states using reinsurance have saved the federal government almost $1 billion, according to a new report from Avalere.
By Les Masterson • March 14, 2019 -
Blues challenge UPMC, call Highmark contract dispute 'of its own making'
The Blue Cross Blue Shield Association argued it's too late for UPMC to intervene in a years-long litigation challenging the way Blues plans operate.
By Samantha Liss • Updated March 15, 2019 -
PBMs called to give patients 'an explanation' by Senate panel
Cigna, CVS Caremark and CVS Health, Humana, UnitedHealth's OptumRx and Prime Therapeutics got invites to the latest Senate Finance Committee hearing. The panel said two of the companies have so far agreed to testify.
By Shannon Muchmore • Updated March 19, 2019 -
AMA says prior authorizations increasing, interfering with care continuity
A new survey of 1,000 physicians found that more than two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization.
By Les Masterson • March 13, 2019 -
Cambia, BCBS of North Carolina link to form $16B insurer
The entity will remain under the Cambia name and be helmed by current Blue Cross North Carolina head Patrick Conway, who formerly led the Center for Medicare and Medicaid Innovation.
By Rebecca Pifer Parduhn • March 13, 2019 -
House panel to launch investigation into short-term 'junk' plans
The Committee on Energy and Commerce will probe companies offering the short-term coverage and "hold them accountable," said Chairman Frank Pallone, D-N.J., including those run by UnitedHealth and Anthem.
By Rebecca Pifer Parduhn • March 13, 2019 -
HHS hints at cutting 'onerous' substance abuse record rules
Deputy Secretary Eric Hargan told attendees at AHIP's National Health Policy Conference to "watch this space very carefully" for changes to the law known as Part 2.
By Rebecca Pifer Parduhn • March 13, 2019 -
Hospital groups say public option would cut payments by 10%
The American Hospital Association and Federation of American Hospitals argue an opt-in government insurance plan would hit bottom lines and disrupt the insurance market.
By Tony Abraham • March 13, 2019 -
Healthcare prices rose but use fell across US from 2012-16
Metro areas along the coast tended to have higher prices than in the Midwest, but there were many examples of neighboring areas with "starkly different" price levels, according to the Health Care Cost Institute.
By Meg Bryant • March 12, 2019 -
Trump admin proposes massive cuts to Medicaid, Medicare
Nearly all items on the wishlist hold zero chance of becoming law, but will likely give Republicans a headache come election time.
By Rebecca Pifer Parduhn • March 12, 2019 -
Population health program growth sputters, though execs agree they're needed
The potential of losing money in risk-based contracts is the most significant reason health systems are resistant to move into value-based care, according to a new Numerof & Associates report.
By Les Masterson • March 12, 2019 -
Pharmas, PBMs and payers all take a slice along drug supply chain, Pew says
As pharmaceutical spending and PBMs take fire in Washington, the report aims to suss out the players pocketing a share as drugs make their way through the system.
By Les Masterson • March 11, 2019 -
MedPAC eyes changes to ED coding, Part B drug pricing
Meanwhile, MACPAC discussed how shortfalls should be counted for Medicaid patients with third-party coverage in the DSH program.
By Les Masterson • March 11, 2019 -
Nashville program looks to tackle uncompensated care costs
The plan comes two years after then-Mayor Megan Barry proposed closing Nashville General as an inpatient facility. About 15% of the city's residents are uninsured or underinsured.
By Les Masterson • March 8, 2019 -
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 -
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 Parduhn • 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
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