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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

Aetna, Humana officially kill merger

Health insurers Aetna and Humana have mutually ended their $37 billion merger agreement two weeks after a federal judge blocked the deal on antitrust grounds. 

$54 billion Anthem-Cigna merger blocked by federal judge

The $54 billion acquisition of Cigna by Anthem has met the same fate as the $37 billion merger of Aetna and Humana: blocked by a federal judge on antitrust grounds. 

Lowered reimbursements are C-suite’s top fear with ACA repeal

In a survey of healthcare executives, many said they want several provisions of the Affordable Care Act (ACA) to stay in place if the law is repealed, while expressing concerns over how its elimination could affect their reimbursements from Medicare and Medicaid.

TeamHealth to pay $60 million to settle overbilling allegations

Physician staffing company TeamHealth has agreed to pay a $60 million penalty to settle allegations that one of its subsidiaries told hospitalists to “up-code” and overbill Medicare, Medicaid and other federal programs.

Healthcare consolidation isn’t driven by ACO participation

While the consolidation trend across healthcare accelerated after the Affordable Care Act (ACA) was passed, there's little evidence connecting consolidation to providers wanting to succeed under accountable care organization (ACO) programs created after the ACA, according to a study published in the February issue of Health Affairs.

Coding intensity could lead to $200 billion spending jump in Medicare Advantage

CMS will likely overpay Medicare Advantage plans by hundreds of billions of dollars over the next 10 years if the agency doesn’t account for coding intensity in its risk scores.

Group purchasing cuts costs, optimizes supply chain

A report from the Healthcare Supply Chain Association (HSCA) said the group purchasing organizations (GPOs) it represents help cut supply chain costs by an average of 15 percent and reduce drug spending by 25 percent.

3 ways to proactively identify underpayments before CMS audits

A Recovery Audit Contractor (RAC) review from CMS isn’t cause for celebration for most healthcare organizations, but it can be beneficial if those facilities take proactive steps to identify underpayments.

CMS proposes 0.25% increase in Medicare Advantage payments for 2018

CMS is offering a more modest 0.25 percent increase in payment rates for Medicare Advantage (MA) insurers, one year after a 0.85 percent hike, in its proposed MA update for 2018. 

Former Tenet exec indicted in $400 million Medicaid fraud case

John Holland, a former senior vice president for Tenet Healthcare’s southern region, has been charged with allegedly taking part in a scheme to pay bribes in exchange for patient referrals and resulting in $400 million in fraudulent Medicaid billings. 

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