Four years into Medicare's drive to cut the number of patients who land back in the hospital within a few weeks of leaving, only a quarter of more than 3,400 hospitals avoided penalties, contributing to skepticism about the program and the array of metrics used to evaluate healthcare quality.
Health insurance premiums on New York's state-run exchange will rise an average of 7.1% next year. But rates differ greatly by payer, plan type and region, highlighting the difficulties of relying on rough averages.
Some hospital system executives are citing booming insurer stock prices as a clear market signal that consolidation will give payers the upper hand in future price negotiations with hospitals and other providers. But insurers are not the only ones seeing strong results.
Patient engagement is a top priority for both health systems and health plans in population health management. So how can health systems and health plans increase patient engagement?
Christopher Dawes, president and CEO of Lucile Packard Children's Hospital at Stanford, a 300-bed hospital in Palo Alto, Calif., discusses the issues raised by Medicaid expansion, narrow-network health plans and high prescription drug costs. He spoke with Modern Healthcare reporter Bob Herman.
Biopharmaceutical companies have begun involving payers, physicians and patient advocacy groups in the early stages of drug development. The goal of partnering bottom line-driven drugmakers with frugal payers is to link the cost of care with patient health outcomes rather than the volume of...
The CMS has revealed reimbursement amounts to compensate health plans as part of the ACA's reinsurance program and some plans may be sorely disappointed.
States and major insurance companies say they need more time to implement new rules meant to offer better coverage of mental-health and substance-abuse treatment to those in Medicaid managed-care plans. The implications are huge for a population that struggles to get care, especially for...
The CMS is about to release a sweeping proposed rule that could fuel a major expansion of Medicaid managed long-term care for elderly and disabled beneficiaries.
A payment reform strategy offering consolidated billing codes and bundled cancer-care payments aims to “fundamentally restructure” the way cancer care is paid for in the U.S.
Dr. Stephen Grubbs has been named senior director of the new clinical affairs department of the American Society of Clinical Oncology in Alexandria, Va.
Last week's Supreme Court 5-4 decision sharply limiting private healthcare providers' right to sue state Medicaid agencies over low payment rates could reduce low-income Americans' access to care.