Healthcare Economics & Policy

Sen. Lamar Alexander, R-Tennessee, has said he’s abandoning efforts to push a bipartisan bill meant to stabilize the Affordable Care Act (ACA) exchanges, putting the blame on Democrats’ resistance to making changes to the law. With no congressional action likely this far into an election year, exchange insurers are requesting some eye-popping hikes for 2019 premiums.

In her remarks at the American Hospital Association’s annual meeting, CMS Administrator Seema Verma, MPH, offered some criticism of current accountable care organizations (ACOs) that haven’t taken on downside risk, hinting those payment models may be targeted by CMS regulations.

According to CNBC, Elliott Management made an all-cash deal for Athenahealth on Monday morning. Elliott’s bid is for $160 a share—a 27 percent premium to the Massachusetts-based healthcare technology company’s Friday afternoon price.

One of Massachusetts’ largest health insurers, Harvard Pilgrim, has been discussing a merger with the state’s dominant healthcare provider, Partners HealthCare, in a move that could dramatically alter the increasingly consolidated market in and around Boston.

If participants in the Medicare Shared Savings Program (MSSP) are required to move into a track which involves downside risk for their organization, they’re likely to leave the program altogether, according to the results of a survey from the National Association of Accountable Care Organizations (NAACOS).

Moody’s Investors Service maintained its stable outlook for the for-profit hospital industry, predicting some small growth in same-facility revenues and patient volumes while margins would remain flat. Looking ahead, however, it advises facilities to pay more attention to value-based care concepts and new technologies like telemedicine and artificial intelligence.

In the latest article in Vox’s series on hospital billing practices, Jessica Pell told a story that isn’t a one-off case: She went to an emergency room (ER), received a minimal amount of help and still got saddled with a massive bill.

Ascension, the largest nonprofit health system in the U.S., has announced a new joint venture with Australia-based hospital operator Ramsay Health Care Limited to create a global supply chain to reduce costs for Ascension’s 2,600 sites of care and the more than 230 facilities Ramsay operates in six countries.

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.