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Payer Roundup—After advocating for AHPs for years, NFIB says it will not establish one

NFIB says the Trump administration's new AHP policy wouldn't really help them. Plus, amid news of rising premiums across the nation, a new…

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AHIP: Rebates not driving rise in drug pricing

A recent analysis prepared on behalf of America's Health Insurance Plans (AHIP) indicates that drug rebates have not been the primary drive…

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Medicare Advantage plans taking advantage of new policies that give them flexibility

"High-touch" services can improve satisfaction among patients with serious or advanced illnesses while reducing costs, a new paper from Duk…

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More than half of Maine prescribers are now EPCS-enabled

Prescription opioid abuse in the U.S. is soaring. As the country's policymakers grapple with how to address this national emergency, gr…

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NIH Clinical Center releases dataset of 32,000 CT images

Lesion data may make it easier for scientific community to identify tumor growth or new disease…

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New Mexico Health Connections to appeal portions of risk adjustment ruling regardless of pending decision

As a New Mexico district judge weighs a request from CMS to reconsider the court's risk adjustment ruling, the lead attorney for New Mexico…

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CMS revives Kentucky waiver debate, puzzling legal experts

CMS plans to open a second 30-day comment period on Kentucky's Medicaid work requirement waiver, a move that has experts scratching their h…

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CMS readies potential fix to risk adjustment payments

The Office of Management and Budget is reviewing an interim final rule from CMS on the "ratification and reissuance of the methodology" for…

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Rural hospitals need more funding for broadband, telehealth, AHA says

The American Hospital Association said rural healthcare entities need more federal funding for technological infrastructure as basic as bro…

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In a blow to PBMs, Trump administration mulling overhaul to drug rebate safe harbor protections 

The Trump administration is considering a proposal to overhaul safe harbor protections for pharmaceutical company rebates, a plan that coul…

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Altarum: Growth in spending on privately insured patients outpacing Medicaid, Medicare

A new analysis from the Altarum Institute found that spending and price growth among the privately insured sped up in 2017 and the first ha…

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GAO finds 340B hospitals are mostly rural or qualify for DSH payments

Amid increased scrutiny of the 340B drug discount program, the Government Accountability Office has released a report diving into the chara…

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Doctors, executives see little progress on value-based care

Value-based healthcare may be the hot topic right now, but all that attention has yet to make much of a mark on the industry. That's the pe…

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VA, IBM Watson Health extend precision cancer partnership to help veterans

The Department of Veterans Affairs and IBM Watson Health have announced a one-year extension to an ongoing public-private partnership apply…

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Maryland health regulator expands hospital price transparency efforts

The Maryland Health Care Commission expanded its price transparency initiative with hospital cost comparison tools to inform consumers abou…

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Payer Roundup—Walmart taps former Humana executive for health unit; Azar appoints value-based care lead

Amid rumors that Walmart is in talks to buy Humana, the retail giant poached one of the insurer’s former vice presidents last week. Plus,…

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CMS head Seema Verma: 'We are not leveraging the value of American clinicians'

The Centers for Medicare and Medicaid Services on Wednesday called for documentation of E/M visits to be scaled back.  The move follow…

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Blue Cross Blue Shield Association reports major drop in opioid prescriptions among members nationwide

BCBS Association Chief Medical Officer Trent Haywood, M.D., attributes the trend to not just educating providers but working with them to c…

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Good or bad idea? Some worry that E/M coding update could underpay doctors with sickest patients

CMS’ plans to update evaluation and management codes is either a good idea that will simplify documentation and free up doctors’ time t…

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HHS reviewing reforms to the Anti-Kickback Statute in addition to Stark Law

During a House subcommittee hearing on Tuesday, HHS Deputy Secretary Eric Hargan said a request for information on changes to the Anti-Kick…

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Premier Management streamlines ACO reporting across 33 metrics to improve quality scores

Premier Management Company manages accountable care organizations. Two of its ACOs are leveraging clinical, financial and operational healt…

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Hospital groups vow to continue legal fight after losing challenge to 340B payment cuts

Groups including the American Hospital Association were part of an effort to fight 340B payment cuts pushed by the Trump administration. Th…

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Emergency physicians sue Anthem over ER policy change

ACEP and the Medical Association of Georgia are asking for a court to put an end to Anthem's new ER policy, which violates federal patient…

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Patient, provider groups urge CMS to reinstate risk adjustment payments

The AMA, AHA and the Federation of American Hospitals were among the 28 groups that say CMS' freeze on risk adjustment payments will cause…

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House Democrats say GOP's ACA repeal efforts could scale back fraud prevention tools

Critical reporting and oversight provisions contained within the ACA would be lost if repeal efforts succeed, argued two Pacific Northwest…

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Continued push to value-based care the key to lower healthcare costs, experts tell legislators 

Policymakers looking to lower healthcare costs must continue to push the industry toward value-based models, experts told legislators at a…

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LabCorp goes down after network breach, putting millions of patient records at risk

Hackers breached one of the largest clinical laboratories over the weekend, forcing a shutdown of the network to contain the cyberattack.

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Broadly acting antibodies found in plasma of Ebola survivors

NIAID-supported discovery could lead to therapy for deadly illness.

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NIH and Prostate Cancer Foundation launch large study on aggressive prostate cancer in African-American men

Researchers will investigate environmental and genetic factors related to aggressiveness of prostate cancer in African-American men.

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CareZone sues Express Scripts for defamation following contract fight

A mounting battle between Express Scripts and online pharmacy CareZone just got a little more heated. Weeks after CareZone accused Express…

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