Author: Andi Rawl

State Medicaid programs are significantly lagging with the adoption of fully electronic claim submissions, claim reimbursements, prior authorizations, and other claims management processes, according to a new Council for Affordable Quality Healthcare, Inc. (CAQH) report. CAQH’s Committee on Operating Rules for Information Exchange (CORE) found that state agencies and health plans covering just 44 percent of […]

In the real world, it has become clear that placing restrictions such as work and reporting requirements on Medicaid is disastrous. They’re legally dubious, for one thing — as a federal judge stated in late June when he tossed out work requirements imposed in Kentucky. More important, they lead to needy beneficiaries being thrown off the program […]

Aiming to cut down on regulatory burdens and give more power to states, the Centers for Medicare & Medicaid Services is making notable changes to the Medicaid program, the biggest source of payment for nursing homes. CMS issued a bulletin late Thursday, outlining “significant improvements” for streamlining Medicaid review processes and reducing approval times. The […]

Though possibly a signal that drug spending could be on the decline in the future, a report from Vizient says health systems will face even higher pharmaceutical prices in 2019, due largely to drugs that have no competition and therapeutics accounting for those that have the biggest share of spending. According to the 2018 Drug Price […]

The blame game continues regarding the escalating cost of drugs, with AHIP this time brandishing a study by Milliman that AHIP commissioned and that says that the rebates pharmaceutical companies offer for certain drugs don’t really have that much of an impact on costs. The drugs that generated the biggest rebates for insurers and PBMs represented only 10% […]

Dive Brief: U.S. insurers can unlock $7 billion in total value — 10-15% of operating expenses — in 18 months by using artificial intelligence to automate certain core administrative functions, according to a new study from Accenture. The savings could stem from streamlining core functions for payers across the board, including customer service, billing, enrollment, claims and quality […]

The Trump administration has been working to weaken Obamacare, while the GOP-run Congress continues to look for ways to defang or undo the controversial health care law entirely. But while the battle rages in the political arenas, states are taking a more practical approach, writing their own rules to expand health care to their constituents. […]

Adapted from Lane et al., 2018, “Best’s Market Segment Report: U.S. Government-Related Health Insurance Business Continues to Grow Despite Risks“; Chart: Axios Visuals Health insurance companies used to collect a majority of their premium dollars from people who had coverage through their jobs, but their growing stake in running government health care programs has consumed a […]

Throughout his residency and his last three years as a physician in psychiatry training at Mather Hospital in New York, Dr. Tamir Aldad saw upfront how thousands of mental health patients each year were sent home from the emergency room knowing they might not get follow-up treatment for several weeks. Despite the urgency of care needed amid […]

Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in an email statement to HealthPayerIntelligence that Alphabet’s infusion of cash provides the payer with the financial resources to scale their current and new insurance […]