Healthcare Economics & Policy

Years of gains in insurance coverage since the Affordable Care Act (ACA) are beginning to reverse, according to a new report from the Commonwealth Fund which found 15.5 percent of working age adults are uninsured, an increase of about four million people since 2016.

Managed care and Affordable Care Act (ACA) exchange insurer Molina Healthcare said its first quarter profits “exceed expectations” after raising premiums for its marketplace plans by about 60 percent and isn’t ruling out returning to markets in Utah and Wisconsin, where it previously offered coverage.

Median earned base-to-bonus ratio—measuring what proportion of compensation comes from incentives beyond base salary—rose for several job titles in 2017.

Envision had sued the insurer in March, alleging UnitedHealthcare “unilaterally” negotiated payment rates and failed to add Envision physicians to its network after the acquisition of AmSurg in 2016. UnitedHealthcare argued Envision’s emergency room billing practices were “egregious,” but also said the lawsuit itself was a violation of the arbitration provision in their contract.

CMS published several of its annual proposed Medicare payment rules on Friday afternoon, covering a slew of facilities like nursing homes, hospices, inpatient rehabilitation and psychiatric hospitals. As predicted, the proposed rule also included regulatory changes in line with CMS initiatives on reducing administrative burden and granting patients easier access to their own data.

If the first quarter of the year is any indication, the frantic pace of mergers and acquisitions (M&A) among hospitals won’t be slowing down in 2018. Thirty transactions were announced between January 1 and March 31, an 11 percent increase over the same period in 2017, according to Kaufman Hall.

In 1999, Amazon bought a 46 percent stake in Drugstore.com and began marketing its products on the Amazon site. Once hailed as “a likely gold mine,” the venture never turned a profit after running into problems with regulations, logistics and the existing pharmacy benefit managers that already dominated the market.

Healthcare real estate investor Welltower has announced it will acquire the outstanding shares of Quality Care Properties and form a joint venture with Toledo, Ohio-based health system ProMedica for the real estate holdings of QCP tenants HCR ManorCare and Arden Courts.

The growth in Medicare Advantage membership has benefited hospitals and physician groups that operate their own plans, with total enrollment increasing by more than 20 percent to three million beneficiaries since 2015.

A new CMS proposal will require hospitals to post their standard prices for treatments online and aims to increase patient access to electronic health records (EHRs).

An academic and insurance executive discussed innovations to control healthcare costs in the U.S., including pricing reforms and payment modifications.

In an April 23 release, CMS announce it is seeking input on an alternative payment model that would allow direct provider contracting (DPC) between payers and primary care or multi-specialty groups. CMS asked for comments to inform possible testing for such a model for Medicare Parts A and B, Medicare Advantage and Medicaid.