Category: FierceHealthPayer

A federal judge has ruled that Prime Healthcare’s lawsuit against Humana over denied or underpaid MA reimbursement can move forward, in what an attorney says is a first-of-its-kind ruling.

While there are whispers that congressional Republicans might try to overhaul the Medicaid program, some AHIP18 speakers believe innovation at the state level represents the real overhaul.

Spending by 14 Blue Cross and Blue Shield insurers on administrative activities increased by almost 6% last year, the highest since 2013. The findings follow another study that found some Blues saved billions under the GOP tax law.

The measures are expected to be bundled and sent to the Senate for consideration.

After watching Martin Shkreli raise the price of a drug by more than 550% in 2015, Intermountain’s Dan Liljenquist had the same thought as the rest of America: Is this really happening? So the system decided to create a nonprofit generic drug company that Liljenquist calls a “first-of-its-kind societal asset.”

The new CEO of the Amazon-Berkshire-JPMorgan healthcare venture offered no specifics on his goals for the organization but acknowledged his presentation at AHIP about healthcare’s inefficiencies would “take on some greater significance.” He also temper…

Under the proposed plan, the Department of Health and Human Services would be renamed the Department of Health and Public Welfare and would establish work requirements for individuals receiving public assistance from any federal agency.

Medicare Advantage plans could soon pay for healthy food, home repairs and transportation to church services if one palliative care specialist gets her way.

Despite proposed double-digit premium hikes for ACA plans in 2019, one insurer is taking a deeper dive into the marketplace and expanding its footprint to several more states.

Health insurer Cigna wants to cut the number of opioid overdoses among its customers by 25% within three years. Thursday’s announcement comes just a few months after the insurer reported it successfully slashed customer opioid use by 25%. Here’s how they plan to target the problem.