All news headlines

Providers are thinking more like payers as industry moves towards population health

While payer-provider collaboration has long been important, new trends in managing population health data is strengthening that relationship as never before, according to MedeAnalytics CEO Andy Hurd, and in many ways it's changing how providers think. Read more »

Out-of-network providers charge on average 300 percent more than Medicare rate, AHIP says

Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to the analysis of 2013 and 2014 claims data released Thursday by the America's Health Insurance Plans. Read more »

Harvard Pilgrim partners with NH providers to create analytics company Benevera Health

New Hampshire hospitals Dartmouth-Hitchcock, Elliot Health System and Frisbie Memorial Hospital are joining with Harvard Pilgrim Health Care to create a new analytics company to manage the clinical and financial data across the organization. Read more »

Chronically ill pay twice as much for drugs on ACA exchanges than through commercial plans, study says

Chronically ill people enrolled in individual health plans sold on the Affordable Care Act insurance exchanges pay on average twice as much out-of-pocket for prescription drugs each year than people covered through their workplace, according to a study published Monday in the Health Affairs journal. Read more »

Capital access holds stable after King v. Burwell decision upholding subsidized health insurance premiums

While the Supreme Court decision in King v. Burwell that cleared subsidized health insurance premiums under the Affordable Care Act removed a lot of uncertainty from hospital finance, little has changed when it comes to hospitals' access to debt. But that may change. Read more »

Payers will have payment glitches under ICD-10, experts say

On Thursday, providers dealt with system issues, which will be followed by productivity issues and then payment issues, according to healthcare insiders. Read more »

True effect of ICD-10 rollout will be felt when claims are processed

Healthcare Finance spent the bulk of Thursday's rollout monitoring the buzz, speaking with experts and reporting on any issues that may have arrived. While the true effects of the change will be felt in the coming weeks when claims are processed, bills delivered and accounts receivable wane, we have a few observations to share. Read more »

CMS should increase oversight of Medicare health plans, GAO states

The federal government needs to increase its oversight over private Medicare health plans to make sure seniors have adequate access to doctors and hospitals, according to a report released this week by congressional auditors. Read more »

Insurers shortchanged $2.5 billion in CMS shared-risk corridor program

Insurance companies will pay $362 million to the federal government's shared risk program beginning this November for 2014 participation, but will be short $2.5 billion in payments that they hoped to receive from the federal government, the Department of Health and Human Services announced on Thursday. Read more »

Live ICD-10 updates: Get the latest news, reactions to the code change

Healthcare IT News and sister site Healthcare Finance will be reporting on the changeover throughout the day, using the live blog below to highlight the latest news, real-time reactions and frequent updates from our cadre of volunteer ICD-10 correspondents. Read more »

Federal court tells CMS hospitals must be able to comment on 0.2% payment cut in two-midnight rule

A federal judge has partly sided with providers in ordering the Centers for Medicare & Medicaid to provide further justification for the 0.2 percent payment reduction in provider compensation that will kick in under the two-midnight rule, according to the September 21 ruling in U.S. District Court in Washington D.C. Read more »

Federal government seeks out uninsured for ACA enrollment

The health law's upcoming enrollment period may be its toughest yet, with federal officials promising a vigorous outreach campaign to enroll millions of eligible yet hard-to-reach Americans who have yet to sign up for health insurance. Read more »

Value-based insurance design offers flexibility in supplemental benefits

The five-year model will be tested in seven states starting in January 2017: Arizona, Indiana, Iowa, Mass., Pennsylvania Tennessee and Oregon. Read more »

Aetna, Anthem CEOs tell Senate that mergers with Humana and Cigna won't stifle competition

Mark T. Bertolini, chairman and CEO of Aetna in Hartford, Connecticut and Joseph R. Swedish, president and CEO of Anthem in Indianapolis, argued before a Senate Judiciary subcommittee on Antitrust, Competition Policy and Consumer Rights on Tuesday that local insurance plans would keep the industry competitive. Read more »

Infographic: Top 11 Health Plans in 2015

The National Committee for Quality Assurance has released its newest rankings for health plans in the United States based on clinical and satisfaction scores.  Read more »

AHIP's Marilyn Tavenner jumps in on drug pricing, Hillary Clinton proposal

Earlier this week, Turing Pharmaceutical CEO Martin Shkreli drew sharp criticism after his privately held company boosted the price of AIDS treatment drug Daraprim from a reported $13.50 a tablet to $750. Read more »

California Department of Insurance rolls out new price transparency website

A new consumer website unveiled by the California Department of Insurance hopes to help Californians better shop for healthcare based on both quality and price. Read more »

Medicare Part D 'donut hole' gap closing amid federal incentives

According to new data released by the Centers for Medicare and Medicaid Services on Monday, the U.S. government has paid nearly $2.3 billion through July in incentives to close the coverage gap in 2015. Read more »

Medicare Advantage premiums to drop by 31 cents by 2016

Medicare Advantage premiums will fall by 31 cents in 2016, the Centers for Medicare & Medicaid Services said on Monday amid surging enrollment to the privately managed program. Read more »

Highest, and lowest ranked health plans by NCQA

The National Committee for Quality Assurance recently ranked more than 1,500 health plans by satisfaction and service. The ranking includes private as well as government-sponsored Medicare and Medicaid plans. Read more »

Private insurance rate increased 1.8 percent as Census shows more people getting coverage

More Americans are getting health insurance either through private or government plans than they were in 2013, according to U.S. Census figures for 2014 released Wednesday that points to the Affordable Care Act as a major driver for the change. Read more »

Payers benefit from new Walgreens and Alegeus partnership

Consumers will earn Walgreens Balance Rewards points for enrolling in and funding accounts, activating benefit debit cards, making purchases using their cards, or by participating in healthy activities such as walking, biking and weight management. Read more »

Employers focus on wellness to reduce health plan costs

Employers again are sharply focused on employee wellness, and some are raising the bar to qualify for program incentives. Read more »

9.9 million sign up for Obamacare, according to CMS

Enrollment figures released this week by the Centers for Medicare & Medicaid Services show close to 10 million people have signed up for insurance through the Health Insurance Marketplace, as of June 30. CMS said 9.9 million individuals had paid their premiums and had an active policy by the end of June. Read more »

Evolent, Health Fidelity partnership targets risk-adjustment

As a Standard & Poor's report finds many insurers are missing the mark on their risk-adjustment predictions, a new partnership between population health management consultant Evolent Health and Health Fidelity, which develops technology to steer providers towards value-based care, aims to fill the gap. Read more »

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