The CMS' Hospital Readmissions Reduction Program is the policy vanguard of the transition from process to outcome measures for hospital reporting and payment.
Mary Brainerd, CEO of HealthPartners, discusses her system's foray into insurance, the challenges faced by providers that want to make similar moves and her own experience in the healthcare system as a patient with breast cancer. She spoke with Modern Healthcare reporter Bob Herman.
America's Health Insurance Plans, the primary lobbyist for the health insurance industry, is funding a “seven-figure” ad campaign that targets Medicare Advantage and aims to put pressure on the Obama administration to stabilize funding for the private version of Medicare.
Health systems and other provider organizations represent a majority of the new participants in the Medicare Advantage program, according to a new Avalere Health study. The paper serves as another talking point for a certain large insurer under the government's antitrust lens right now.
Former CMS chief Marilyn Tavenner discusses her move to head up America's Health Insurance Plans and the challenges faced by the group's members, which have struggled in the fledgling insurance marketplaces created under the ACA.
The CMS’ previous administrator, Marilyn Tavenner, criticized the agency after an analysis showed it has underpaid Medicare Advantage plans for the costs of treating individuals with chronic conditions.
The CMS has made it easier for providers to opt out of meaningful use requirements in the federal electronic health record program. In December, a new federal law authorized the CMS to batch process hardship applications by categories instead of the case-by-case method previously used.
The CMS has banned Cigna from offering new Medicare Advantage plans after finding issues with the way the insurer handled appeals, grievances and its drug formulary. Investors don't believe the sanctions would affect the insurer's pending deal with Anthem.
The latest iteration of Medicare's accountable care experiment paves the way for more doctors and hospitals to evolve toward starting their own Medicare Advantage plans, stoking a trend that's already well underway.
Anthem Blue Cross and Blue Shield in Ohio and physicians of the Ohio Independent Collaborative (OIC) have launched an arrangement for Anthem Medicare Advantage members to promote greater preventative care, enhanced care coordination and chronic disease management.
MedPAC voted Thursday to request that Congress pass legislation letting the HHS secretary eliminate benchmark caps and “double bonuses” now given to Advantage plans. That proposal comes after a series of whistle-blower cases that allege providers and Advantage plans bilked the system.
Aetna's departure from AHIP months after UnitedHealth Group bolted is further evidence that the large national insurers are increasingly happy to fight their own battles on Capitol Hill, such as shepherding their pending mega-mergers and negotiating changes to the ACA marketplaces.