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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 CEO: ‘No intention’ of being in ACA market for 2018

Aetna CEO Mark Bertolini said the uncertainty surrounding the Affordable Care Act (ACA) and its insurance marketplace is too big of a risk for his company, saying it has “no intention of being in the market for 2018.”

How pulling Healthcare.gov ads could lead to insurer losses in 2017

The administration of President Donald Trump has cancelled advertisements and outreach efforts designed to encourage people to sign up on the health insurance marketplace in the final days of open enrollment, a move which could lead to a sicker, older risk pool for insurers. 

Court freezes CMS rule on premium assistance for dialysis patients

A federal judge has temporarily blocked a CMS rule on requiring dialysis companies to disclose all charitable premium assistance they provide to patients. 

Johnson & Johnson shopping its diabetes care division after cautious 2017 forecast

Three diabetes care units within Johnson & Johnson (J&J) could be sold, the company said, as it reported slightly better-than-expected earnings for the last quarter of 2016 and lowered expectations for the current year.

Federal judge blocks Aetna-Humana deal on antitrust grounds

Aetna’s $37 billion acquisition of Humana has been blocked by a federal judge, who ruled it would violate antitrust laws and seriously limit competition in the Medicare Advantage (MA) market and a handful of health insurance exchanges. 

Radiologists, emergency docs may charge 4 times Medicare rate to out-of-network patients

In a study examining what specialists may charge to out-of-network or uninsured patients, radiologists, neurosurgeons and emergency physicians ranked near the top of the list of highest markups compared to Medicare rates.

 

359,000 clinicians participating in 4 APMs in 2017

CMS has announced which clinicians and accountable care organizations are participating in four alternative payment models (APMs) in 2017: the Medicare Shared Savings Program (MSSP) Next Generation ACO Model, the Comprehensive End-Stage Renal Disease Care Model (CEC) and Comprehensive Primary Care Plus (CPC+) Model. 

Surgical Care Affiliates being sold to UnitedHealth’s Optum for $2.3 billion

Wakefield, Massachusetts-based Optum, owned by UnitedHealth, has agreed to a $2.3 billion cash and stock deal to buy Surgical Care Affiliates (SCA) and its 190 surgical hospitals and ambulatory surgical centers.

More than 1 million healthcare jobs would be lost with ACA repeal

The healthcare industry would suffer the greatest job losses due to the loss of federal funds if parts of the Affordable Care Act (ACA) are repealed, according to an analysis from the Commonwealth Fund.

 

Bundled payments for joint replacement could save hospitals $2 billion

A study in JAMA Internal Medicine found hospitals can save an average of 8 percent without impacting quality in Medicare’s bundled payment for joint replacement.

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