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CMS proposes site-neutral payments in OPPS rule aimed at boosting provider competition
The proposal, released by CMS on Wednesday, will save patients approximately $150 million in copayments each year, according to the agency. Administrator Seema Verma said the current system is to blame for provider consolidation.
Self-insured employers will determine the fate of payment reform, analysts say
Self-insured employers are the largest payer of health insurance, but most are reluctant to move away from fee-for-service. In order to shift the balance toward value, employers have to start recognizing their market power, Brandeis University research…
Anthem CEO optimistic about Medicare Advantage going into second half of 2018
Despite a decline in membership overall, the insurer is confident that it will increase enrollment in its Medicare Advantage plans, including retirees from the commercial market.
Anthem Blue Cross Medi-Cal signs on to state’s Health Homes Program
In collaboration with another participant, the plan seeks to coordinate care for some of California’s most vulnerable residents, beginning in San Francisco this summer.
Payer Roundup—House to vote on slew of HSA bills; Bright Health partners with Mercy in Ohio MA market
The floor votes on health savings accounts follow contentious debates in committee last week. In other healthcare news, Bright Health has joined forces with Mercy Health to offer MA plans in Ohio, and physicians are tepid about changes to fee schedule.
Payer Roundup—After advocating for AHPs for years, NFIB says it will not establish one
NFIB says the Trump administration’s new AHP policy wouldn’t really help them. Plus, amid news of rising premiums across the nation, a new study suggests state individual mandates could be the cure.
Medicare Advantage plans taking advantage of new policies that give them flexibility
“High-touch” services can improve satisfaction among patients with serious or advanced illnesses while reducing costs, a new paper from Duke-Margolis says.
CMS revives Kentucky waiver debate, puzzling legal experts
CMS plans to open a second 30-day comment period on Kentucky’s Medicaid work requirement waiver, a move that has experts scratching their heads, especially as numbers from Arkansas’ work requirement demonstration roll in.
Payer Roundup—Walmart taps former Humana executive for health unit; Azar appoints value-based care lead
Amid rumors that Walmart is in talks to buy Humana, the retail giant poached one of the insurer’s former vice presidents last week. Plus, two investigations suggest insurers and pharma are trying to dodge the law.
Blue Cross Blue Shield Association reports major drop in opioid prescriptions among members nationwide
BCBS Association Chief Medical Officer Trent Haywood, M.D., attributes the trend to not just educating providers but working with them to change their prescribing behavior.
