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Pharmacy benefits manager Express Scripts said it will lose Anthem as a client when its current contract expires at the end of 2019, claiming it can’t agree to the price concessions Anthem has been demanding.

Medical equipment giant Becton, Dickinson and Co. (BD) is getting bigger, announcing a $24 billion cash-and-stock deal to acquire CR Bard, including its portfolio in oncology, vascular and surgical products.

Mergers and acquisition (M&A) activity in healthcare isn’t slowing down, with the first quarter of 2017 being the tenth straight with more than 200 deals. What did change, according to a report from PricewaterhouseCoopers (PwC), was the disclosed value of those transactions.

HHS Secretary Tom Price and CMS Administrator Seema Verma have both expressed skepticism about making bundled payments mandatory for providers in certain regions, but switching them to voluntary participation could slow the transition to value-based care, according to five Brookings Institution experts writing in a Health Affairs blog post.

Despite claims by President Donald Trump, Republican members of Congress, and some insurance CEOs, the Affordable Care Act (ACA)’s health insurance exchanges aren’t in a death spiral, according to a Standard and Poor’s (S&P) analysis, which predicts the individual market is actually on a path to profitability in 2018.

 

Recent Headlines

Hospital chargemaster rates linked to higher payments, but not higher quality care

The list prices for hospital procedures and tests aren’t “inconsequential,” according to economists, and can be associated with higher payments from insurers and patients.

 

Medicare Advantage plans get better than expected rate hike for 2018

Payments to insurers offering Medicare Advantage plans will increase by an average of 0.45 percent, according to the final rate notice issued by CMS, above the 0.25 percent bump in pay the agency had previously proposed.

CMS: Medicaid DSH payments will consider what Medicare, third-party pay

In a final rule issued on March 30, CMS clarified uncompensated care costs for Medicaid patients are limited by what a hospital received from other sources, such as commercial insurers, Medicare or the patients themselves.

ACHE 2017: Creating a provider-sponsored health plan means understanding your market

The lines are blurring between healthcare providers and payors as more providers are sponsoring their own health plans or partnering with payors. Unfortunately for interested providers, that greater prevalence hasn’t come with any one-size-fits-all approach for making these plans succeed.

Anthem likely to leave ACA markets for 2018

Financial analysts are predicting Anthem, one of the nation’s largest health insurers, will be following other national companies in leaving the Affordable Care Act’s exchanges in 2018.

500,000 healthcare jobs added because of ACA

A new analysis from Goldman Sachs said that 500,000 of the jobs added to the healthcare sector since 2012 can be attributed to the Affordable Care Act (ACA)’s increasing of health insurance coverage. 

Cleveland Clinic operating income drops by 71%

Revenues were up at the Cleveland Clinic in 2016, but higher expenses put a damper on operating income, which fell 71 percent from the year before.

Former Anthem lobbyist to be nominated to run DOJ’s antitrust division

The specific division of the U.S. Department of Justice that fought Anthem’s $54 billion acquisition of Cigna—and which the insurers is still pushing to approve the merger over antitrust concerns—could be run by a former Anthem lobbyist.

Mayo Clinic facing state review for prioritizing privately insured patients

Mayo Clinic is being reviewed by the Minnesota Department of Human Services (DHS) for possibly breaking civil and human rights laws after comments from CEO John Noseworthy, MD, encouraging employees to prioritize commercially insured patients over Medicare and Medicaid beneficiaries.

Winners and losers in Trump’s proposed budget for HHS

President Donald Trump’s budget proposal for 2018 would reduce funding to HHS by $15.1 billion, a cut of nearly 18 percent, eliminating millions for education and training programs for healthcare professionals, while cutting $5.8 billion from the National Institutes of Health (NIH) alone.

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