Google has 14 years on Oscar, but both companies focus on reaching consumers in a technologically advanced, disruptive way.
Category: FierceHealthPayer
DOJ expands Medicare Fraud Strike Force to Newark and Philadelphia
The Justice Department selected the cities for the Strike Force’s newest division due to the prominence of fraud, including illegal opioid distribution, in the region.
CMS’ ACO proposal resurfaces discord over pace of risk-based models
Although some ACOs may leave the program, the goal should be quality over quantity, says former Obama health IT official Farzad Mostashari. But NAACOs says Track 1 ACOs need more time to get their bearings.
The big 8 insurers made $16.6B in the first half of 2018. Here’s how they stack up
The first half of 2018 is in the books for insurers, and the field looks substantially different from last year. Most notably, Aetna’s net income jumped over 100%, Humana took a large hit from last year’s earnings and Molina made a small but notable co…
Industry Voices—We need ‘activist’ employers like Amazon to change healthcare as we know it
Waking up to the fact that they are paying for 50% of healthcare spending, employers like Amazon, JPMorgan Chase and Berkshire Hathaway are beginning to take on incumbents—insurance companies, hospitals, existing health systems and specialty care—by co…
CMS pushes ACOs to take on more risk with Medicare Shared Savings Program overhaul
A long-awaited rule from CMS would shorten the time frame that ACOs are allowed to be in an upside-only risk model to two years, a move that is likely to drive providers out of the program.
Azar: New HHS guidance aimed at curbing drug companies’ ‘abusive behavior’ in Medicaid
HHS has issued guidance aimed at blocking drug companies from manipulating a loophole in Medicaid’s payment policies that they can use to avoid paying out full rebates for certain medications.
CMS issues proposed rule justifying risk adjustment methodology
CMS’ newest explanation is the latest chapter in a months-long saga that started with a federal court ruling vacating the methodology in February.
Focus on advanced primary care improves success of ACOs, study finds
What do the most successful accountable care organizations (ACOs) have in common? A focus on advanced primary care, according to a new study.
CBO: States not enrolling beneficiaries in managed care in cost-effective way
The elderly and disabled and those who also qualify for Medicare cost more to cover, but Medicaid may not be covering them in the most cost-effective way.
