HL7 releases latest FHIR version | Healthcare Dive
The new iteration brings normative status, meaning future changes will be backward compatible.| Healthcare Dive
The new iteration brings normative status, meaning future changes will be backward compatible.| Healthcare Dive
After a 94-5 vote to pass the the legislation, the sweeping regulatory package heads to President Obama's desk.| Healthcare Dive
Meanwhile, the coalition Health IT Now sent a letter to ONC chiding the government for failing to implement information blocking provisions of the 21st Century Cures Act.| Healthcare Dive
It’s a positive development for the insurer, which sued the government earlier this year after its quality scores fell dramatically.| Healthcare Dive
The insurer is actively seeking ways to mitigate the financial impact of its star ratings drop, Elevance CEO Gail Boudreaux said during the insurer’s third-quarter earnings call.| Healthcare Dive
The payer is taking issue with how regulators calculated quality scores for 2024, after seeing a stars decline that could cause its bonus revenue to fall by $500 million.| Healthcare Dive
The insurer argued the CMS didn’t follow its stated methodology for calculating quality scores, causing its rating to drop and risking millions of dollars in payments.| Healthcare Dive
The Medicare trustees’ new projection for insolvency is five years later than previous forecasts, but budget hawks warned action is still needed to shore up the insurance program’s finances.| Healthcare Dive
The redo comes after regulators lost two court cases over the methodology used to determine 2024’s quality ratings and should result in hundreds of millions of dollars in additional bonuses to plans.| Healthcare Dive
Texas Judge Reed O’Connor once again ruled against the Affordable Care Act. The health law requires employers to purchase insurance coverage that includes coverage for PrEP medication.| Healthcare Dive
It’s the latest warning about the impact to the healthcare system if the subsidies are allowed to lapse.| Healthcare Dive
Insurers plan to keep sacrificing MA growth for profitability next year, after second quarter results for Humana and CVS showed the success of the strategy.| Healthcare Dive
Certain states and specialties will face acute shortages, while others will see a surplus of workers, according to a new study from Mercer.| Healthcare Dive
The final tally from the nonpartisan budget scorekeeper estimates the law will decrease federal healthcare spending by $1.1 trillion over the next decade.| Healthcare Dive
States have just weeks to submit their applications for the new Rural Health Transformation Program, but the CMS says its ability to provide support may be delayed due to the government shutdown.| Healthcare Dive - Latest News
The layoffs will impact between 600 and 700 employees.| Healthcare Dive - Latest News
The technology giant is working with Hackensack Meridian Health on multiple agents, including a tool that can summarize patients’ medical records for providers.| Healthcare Dive - Latest News
ICHRA plans, a nascent form of health coverage, are gaining traction, argues an executive of Centene subsidiary Ambetter Health.| Healthcare Dive - Latest News
The clinical assistant will be able to record nurses’ interactions with patients and help document their care. The tool will be generally available in the U.S. starting in December.| Healthcare Dive - Latest News
The deal would offer UPMC an entrance into the Ohio market.| Healthcare Dive - Latest News
The CMS administrator’s comments at an industry event in D.C. on Wednesday reflect the difficult tightrope regulators in the Trump administration walk as they pursue MA reform.| Healthcare Dive - Latest News
Gov. Gavin Newsom signed an array of healthcare bills into law last week that crack down on pharmacy benefit managers and beef up the review process for deals involving private equity firms.| Healthcare Dive - Latest News
As providers and payers navigate an increasingly challenging financial environment, executives are targeting AI tools that show a clear return on investment, according to a report by Klas Research and Bain & Company.| Healthcare Dive
Providers blasted the ruling, which will appealed to a higher court.| Healthcare Dive
A wide swath of industry groups cheered the ruling, which held the plaintiffs lacked legal standing to bring the case.| Healthcare Dive
The final rule issued last week prevents insurers from paying brokers additional fees for steering beneficiaries to their plans.| Healthcare Dive
The Fifth Circuit Court of Appeals’ decision Friday is a win for the upwards of 150 million people that receive health insurance through their employers. However, it paves the way for future lawsuits from opponents of the ACA.| Healthcare Dive
More than 20 screenshots of potentially stolen patient data were posted on the dark web for about a week, the insurer said.| Healthcare Dive
Because of the cyberattack on Change Healthcare earlier this year, providers say they’re having difficultly getting the necessary information from plans required to kick off the dispute resolution process.| Healthcare Dive
The Medicare funding program, which launched in March to ease cash flow challenges for providers, will stop accepting applications July 12.| Healthcare Dive
More than $14 billion in claims have been prepared for processing and will start flowing soon, the technology firm said Friday.| Healthcare Dive
The update is a win for provider groups who have urged the agency to clarify which organizations need to report a data breach and notify patients after the cyberattack.| Healthcare Dive
Legislators slammed Andrew Witty over the company’s lack of cybersecurity practices and the impact of the breach, which may have compromised the data of a third of Americans.| Healthcare Dive
In a Thursday letter, the American Hospital Association urged the HHS’ Office for Civil Rights to reduce possible “duplicative” breach notifications from the Change cyberattack.| Healthcare Dive
AmeriLife’s suit joins at least two others from MA sales groups seeking revisions to the rule for threatening their business model. It also comes with a clock, given a looming deadline for marketing contract negotiations.| Healthcare Dive
A pact to offer “most favored nation” prices to state Medicaid programs and via direct-to-consumer channels doesn’t affect those on commercial insurance or who won’t pay out of pocket.| Healthcare Dive
Medical leaders including the HHS argue the ruling against race-conscious admissions policies could roll back gains in the number of minority physicians and ultimately hurt health outcomes.| Healthcare Dive
Sens. Ron Wyden and Elizabeth Warren are seeking more information from the beleaguered healthcare behemoth after The Guardian found it was incentivizing nursing homes to reduce hospital transfers.| Healthcare Dive
Creagh Milford is taking the reins at the value-based medical group for seniors after Oak Street’s previous president decided to step down.| Healthcare Dive
The company raised its outlook as many insurers are struggling with elevated medical costs in the second quarter.| Healthcare Dive
With the deal’s completion, CVS adds a multi-state chain of medical clinics for seniors to its primary care roster.| Healthcare Dive
The combined company will work on care delivery and engagement, particularly for Medicare Advantage customers, according to an announcement.| Healthcare Dive
Jon Thiboutot, most recently the vice president of operations of CVS' MinuteClinic subsidiary, has been named the healthcare giant's president of retail health.| Healthcare Dive
The findings build on other research suggesting that MA insurers restrict care more than they should, especially post-acute services.| Healthcare Dive
In a new report from Medscape, physicians say a lack of qualified applicants is hampering efforts to fill open positions. Many worry the situation could get worse over the next decade.| Healthcare Dive
More than half of respondents saw more procedure complications or reported poor outcomes due to care delays, while 28% said mortality rates rose.| Healthcare Dive
CMS will provide states monthly reports of beneficiaries whose citizenship or immigration status cannot be confirmed. States are expected to take “appropriate actions” including limiting coverage, the agency said.| Healthcare Dive
Lawmakers on both sides of the aisle are taking a harder look at coverage denials, fraud and waste in the popular program.| Healthcare Dive
The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.| Healthcare Dive
Nearly three in four providers surveyed by Experian Health said the number of claims denied by payers shot up between 2022 and 2024.| Healthcare Dive
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.| Healthcare Dive
The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.| Healthcare Dive
Physicians surveyed by the American Medical Association say prior authorization can cause care delays or force patients to abandon treatment. Denials could also increase as insurers adopt AI to review claims.| Healthcare Dive
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.| Healthcare Dive
Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.| Healthcare Dive
The CMS plans to trial prior authorization requirements in traditional Medicare. A group of Democrat representatives think that’s a bad idea based on the tool’s track record in Medicare Advantage.| Healthcare Dive
Less than two weeks after stepping down, Prasad will return to lead CBER “at the FDA’s request,” an HHS spokesperson said. It's the latest twist in an unusual run to lead the FDA office overseeing vaccines and gene therapy.| Healthcare Dive
The healthcare juggernaut’s results came in unusually below Wall Street’s expectations and caused its stock to plummet Thursday. The development bodes ill for the rest of the managed care sector, analysts said.| Healthcare Dive
Osterhaus Pharmacy in Iowa — which is also suing CVS Caremark — is taking issue with pharmacy benefit managers’ use of performance-based fees that it says are contributing to independent pharmacy closures.| Healthcare Dive
The bipartisan agreement will fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.| Healthcare Dive
The PBM Act would make companies like CVS and UnitedHealth that own health insurers or PBMs sell pharmacy assets. That would help independent pharmacies, but may not help patients, according to one expert.| Healthcare Dive
Agency commissioners voted unanimously on Tuesday to publish the report, which makes similar allegations against the controversial drug middlemen as the agency’s first report released last summer — but relies on more data.| Healthcare Dive
The KFF’s projection is steeper than an older analysis that relied on less complete data. It’s the largest increase that ACA insurers have asked for in more than five years as payers brace for membership turmoil.| Healthcare Dive
The American Civil Liberties Union called the ruling “a major victory for public health.” Federal officials are exploring their legal options, including an appeal.| Healthcare Dive
The Government Accountability Office can file a lawsuit in an attempt to restore the grants. However, the agency has not opted to do so during the second Trump administration.| Healthcare Dive
The healthcare giant’s new estimate is roughly $1 billion higher than previous forecasts as the cyberattack on subsidiary Change Healthcare continues to hamper its profit outlook.| Healthcare Dive
Centene continued to deal with a mismatch between Medicaid rates and patient acuity in the second quarter, but still exceeded Wall Street’s expectations thanks to Affordable Care Act growth.| Healthcare Dive
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.| Healthcare Dive
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.| Healthcare Dive
CenterWell said it will lease space at Walmart Supercenter stores in four states.| Healthcare Dive
Financial challenges at rural hospitals — driven by reimbursement problems — are leading facilities to shutter labor and delivery wards, the report found.| Healthcare Dive
One challenge hospitals face is reimbursement from private payers, which doesn’t cover the higher costs of care in rural areas, according to a report by the Center for Healthcare Quality and Payment Reform.| Healthcare Dive
Dually classifying allows urban facilities to benefit from rural health programs, even as many rural facilities struggle financially and are at high risk of closure, researchers wrote.| Healthcare Dive
Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.| Healthcare Dive
Pharmacy benefit manager lobby PCMA and drugmaker lobby PhRMA pointed fingers over problems in the prescription supply chain during the House committee's second PBM hearing on Tuesday.| Healthcare Dive
Antitrust regulators are poised to file suit against CVS Caremark, Express Scripts and Optum Rx over how they negotiate discounts for drugs, including insulin, according to the report.| Healthcare Dive
The report is not positive for the drug middlemen, which immediately criticized it as one-sided.| Healthcare Dive
Pharmacy groups cheered the news, which reversed a vote earlier this year by FTC commissioners not to investigate PBMs' pricing and contractual practices.| Healthcare Dive
The major PBM said its lawsuit is necessary to protect against misinformation about the controversial drug middlemen, while the FTC promised to defend its research.| Healthcare Dive
The Cigna-owned pharmacy benefit manager colluded with rival Prime Therapeutics to overcharge pharmacies, according to a lawsuit filed last week.| Healthcare Dive
Pharmacy benefit managers have largely avoided the brunt of public blame for the deadly opioid crisis. Arkansas’ lawsuit brings the drug middlemen back to the forefront of the controversy.| Healthcare Dive
Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.| Healthcare Dive
The infusion services and drug therapy company will operate under CarelonRx, Elevance’s pharmacy benefit manager.| Healthcare Dive
Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.| Healthcare Dive
The investment, which the foundation says is its largest in women’s health, will support research in maternal health, obstetric care and sexually transmitted infections, among other areas.| Healthcare Dive
A coalition of 16 states and Washington, D.C. argue the Trump administration is trying to ban youth gender-affirming care without going through Congress.| Healthcare Dive
The watchdog said the payer submitted documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were.| Healthcare Dive
The payer said it plans to vigorously defend its practices as the lawsuit alleges it put profits ahead of compliance.| Healthcare Dive
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.| Healthcare Dive
Lagging vaccination rates lead the company to expect the pandemic to be a "modest negative for 2021," CFO Shawn Guertin said. Previously, it expected COVID-19 to have little to no impact on full-year earnings.| Healthcare Dive
The insurer is the latest to face allegations of receiving Medicare Advantage overpayments tied to patients who were inaccurately identified as part of a high-risk group.| Healthcare Dive
More than 60 companies, including Amazon, Google, UnitedHealth and Epic, have pledged to participate in the initiative, which the CMS said would “deliver results” early next year.| Healthcare Dive
Few concrete details emerged from the branding bid, but Haven's website and a letter from CEO Atul Gawande set lofty guiding principles for the venture.| Healthcare Dive
Legislation passed earlier this year also expanded premium tax credits and helped drive down premiums. More than 90% of those who enrolled during the SEP saw their premiums reduced.| Healthcare Dive
For most payers, higher-than-expected coronavirus costs were offset by patients continuing to delay nonessential medical care.| Healthcare Dive
An ongoing SEC probe could pose a significant risk to the payer, which gets most of its revenue from government programs.| Healthcare Dive
At question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.| Healthcare Dive
Children are at highest risk in Texas, Florida and Georgia when states resume checking Medicaid eligibility after the public health emergency expires, Georgetown University researchers found.| Healthcare Dive
The three-year continuation of enhanced subsidies for Affordable Care Act plans should help millions afford coverage and create some revenue stability for payers and hospitals in a tricky operational environment.| Healthcare Dive
Policy experts are worried, however, that progress on coverage expansion will be threatened when a moratorium on Medicaid disenrollment ends.| Healthcare Dive
