CMS had requested comments on allowing direct provider contracting (DPC) with Medicare beneficiaries in the form of the alternative payment model. Among major healthcare groups, the response was decidedly mixed, ranging from cautious optimism to telling CMS to focus on other payment reforms.

One of the largest insurers in the U.S. behind the Big Five of UnitedHealthcare, Aetna, Anthem, Cigna and Humana, WellCare would add more Medicaid and Medicare Advantage (MA) members with the purchase of Meridian Health Plans.

The legislation, sponsored by California Assemblyman Ash Kalra, a Democrat from San Jose, would have created a state commission to set rates for many medical services currently covered by private insurers in the group and nongroup markets.

Total community benefit spending increased from $15.3 billion in 2012 to $18.4 billion in 2015—a 20.14 percent jump in terms of the raw dollars and a 15 percent increase after adjusting for inflation.

In a systemwide change, Brian Dean, MPH, MBA, will become the new CFO for Memorial Hermann.

“It’s carrot and stick,” one person familiar with the strategy told Politico. “You’re with us or against us. It’s your call, but being against us is not going to stop us.”

Michael Frank has worked for health insurance companies for decades, doing the actuarial science which determines how much people should pay in monthly premiums. He knows insurers are supposed to be his “advocate” to restrain costs and get him a fair rate—so he was shocked when Aetna agreed to pay $70,000 to NYU Langone Medical Center in New York City for his partial hip replacement.

Hospitals will be expected to perform fewer unnecessary C-sections, cut down on imaging procedures for lower back pain and prescribe fewer opioids. If they don’t do so by the end of 2019, Covered California will try to get participating health insurers to exclude those hospitals from their networks.

According to the Boston Globe, plaintiff Stephen Zappala, MD, said the pressure went as far as Steward representatives calling his patients and telling them their operations had to be performed at Steward-owned facilities even if Zappala had referred them elsewhere.