Regional insurers bet big on virtual-first plans

Over the past few years, an increasing number of regional insurers have launched virtual-first plans for the first time, in a move to differentiate themselves from larger insurers in their markets.  »

MedPAC votes to boost hospital payments, freeze or cut other providers

The Medicare Payment Advisory Commission doesn't expect the recommendations to decrease Medicare beneficiaries' access to care or lower quality.

Most Next Gen ACOs achieved bonuses in 2019

Overall, the 37 ACOs earned about $461.9 million in shared savings. The model is now in its final performance year.

Congress recalibrates Medicare Physician Fee Schedule after lobbying

Specialty physician groups successfully fought to mitigate pay cuts after the Medicare Physician Fee Schedule was released.

CMS approves rule to encourage value-based drug pricing

CMS approved its plan to make it easier for private insurers, state Medicaid programs and prescription drug manufacturers to create value-based payment arrangements tied to clinical outcomes.

Medicaid MCOs covering dual-eligibles to join direct contracting

Medicaid managed care organizations serving beneficiaries dually eligible for Medicaid and Medicare will be able to take part in the CMS Innovation Center's new direct contracting model.

CMS wants to force insurers to ease prior authorization

The proposed rule would require payers—including Medicaid, Children's Health Insurance Program and exchange plans—to build application program interfaces to support data exchange and prior authorization.

CMS unveils highly anticipated geographic direct-contracting model

The model aims to improve health outcomes and lower costs for Medicare's fee-for-service beneficiaries in entire regions. Modern Healthcare discussed it with CMS Administrator Seema Verma in an exclusive interview before the announcement.

CMS finalizes physician-owned hospital boost, end of inpatient-only list

CMS on Wednesday moved forward with changes designed to increase provider competition, including allowing physician-owned hospitals to expand under certain circumstances.

Physician fee-schedule changes could upend compensation, experts say

Providers are struggling to predict how changes to primary- and specialty-care payments will shake out, because nobody knows how COVID-19 will affect their practices in the next two quarters. They have a month to prepare.