There has been heightened scrutiny over pharmacy benefit managers' role in drug pricing in recent years. Anthem's creation of its own pharmacy benefit management company could drive change throughout the industry as health plans and PBMs aim to maintain their competitive edge, experts said.
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Healthcare news this week …
Even before President Donald Trump announced plans last week to nix Obamacare subsidies, the Illinois Department of Insurance raced over the summer to get insurers on board with a strategy to minimize the financial pain of such a move.
Opioids accounted for 24% of medication malpractice claims, making it the leading cause of such claims from 2012 to 2016.
The American Medical Association is throwing its hat into the data and interoperability game with the launch of the Integrated Health Model Initiative, which will develop a framework for the industry to collect, organize and share health data that complements the ONC's standards work.
Anthem is starting a pharmacy benefit manager in partnership with CVS Health after cutting ties with its longtime PBM, Express Scripts. Starting in 2020, when Anthem's Express Scripts contract ends, the new PBM will serve customers of Anthem-affiliated health plans and non-Anthem customers.
Although most value-based pay models focus on primary care services, providers and policy experts hope the recent financial success of accountable care organizations targeting dialysis patients will lead to more disease-specific pay models.
Cleveland HeartLab has agreed to be acquired by Quest Diagnostics, a Fortune 500 medical testing company based in New Jersey.
Highmark Health will spend $1 billion to expand its Allegheny Health Network hospital chain, including a new 160-bed hospital in Pittsburgh's North Hills suburbs, four smaller neighborhood hospitals and renovations to existing hospitals.
Google Maps ditches calorie counting, drug companies knowingly make eye drops that are too big and bodies heal themselves.
UnitedHealth Group's third-quarter earnings soared 26% to beat Wall Street expectations as its growing Optum business segment once again helped the nation's largest health insurer.
Rep. Tom Marino will no longer be considered to lead the Office of National Drug Control Policy. His decision comes just days after news reports revealed he played a critical role in passing legislation that weakened federal authority to control opioid distribution.
Hospitals say President Donald Trump's expected declaration that the opioid epidemic is a national crisis will have little impact on their strategies to combat abuse.
Two key senators have reached a bipartisan agreement to extend funding for cost-sharing reduction payments to insurers for two years in exchange for greater state flexibility on insurance market rules. While the proposal has industry support, it's unclear whether it can clear Congress.
Richard Breon, president and CEO of Grand Rapids, Mich.-based Spectrum Health, announced Tuesday he will retire in 2019 after 17 years at the helm of the system.
The University of Illinois' new medical school in Urbana-Champaign has earned preliminary accreditation that allows it to accept applications for its first class.
Health system and hospital consolidation in 2017 will likely outpace 2016's mark and continue at the same pace through next year as systems get more creative with their partnerships, experts said.
The rulings said home health aides who don't live full time with their clients should be paid for every hour of a 24-hour shift.
The U.S. Justice Department dumped its lawsuit accusing UnitedHealth Group and affiliated health plans of exaggerating how sick its patients were to score millions of dollars in inflated Medicare Advantage payments.
Microsoft blames North Korean for WannaCry cyberattack, states sue Trump over insurance subsidies, and the flu shot depends on herd immunity.