Plus, Biden admin proposes arbitration overhaul

This Week

Nov 4, 2023

Nearly a quarter of hospital stent procedures are unnecessary, fueling billions in low-value spending, Lown Institute finds


Once a high-flying 'unicorn,' Olive AI sells two key businesses, winds down operations


Biden admin proposes overhauls to lambasted out-of-network billing dispute resolution process


Payers shortchanged $1.1B in ACA risk adjustment payments as Bright, Friday fail to meet obligations: CMS


Amazon's Rx to fix the pharmacy experience as brick-and-mortar drugstores struggle - Paige Minemyer

 

Featured

Nearly a quarter of hospital stent procedures are unnecessary, fueling billions in low-value spending, Lown Institute finds

U.S. hospitals gave a medically unnecessary coronary stent every seven minutes between 2019 and 2021, according to a new analysis.
 

Top Stories

Once a high-flying 'unicorn,' Olive AI sells two key businesses, winds down operations

It marks the end of the line for healthcare automation startup Olive AI. The company sold its clearinghouse and patient access business units to Waystar and its prior authorization business unit to Humata Health.

Biden admin proposes overhauls to lambasted out-of-network billing dispute resolution process

A proposed rule would bring new filing and notification requirements, fee changes and other adjustments federal departments say will increase efficiency and accessibility.

Payers shortchanged $1.1B in ACA risk adjustment payments as Bright, Friday fail to meet obligations: CMS

Bright Health Group and Friday Health Plans are both unable to pay their dues into the 2022 Affordable Care Act risk adjustment pool, CMS said.

Amazon's Rx to fix the pharmacy experience as brick-and-mortar drugstores struggle

Amazon Pharmacy's focus on making it faster and more convenient for patients to get prescription medications comes as brick-and-mortar drugstores are limiting pharmacy hours and even closing locations across the country.

Biden to sign sweeping executive order pursuing 'safe, secure and trustworthy' AI development

Within healthcare, the order instructs HHS to establish safety programs and strategic plans focused on unsafe healthcare practices involving AI.

CMS finalizes $140M increase to home health payments

CMS' new proposed rule will increase home health payments by 0.8%, or $140M, among other changes.

Cleveland Clinic to launch prescription delivery via drone in 2025, starting with specialty and rush medications

Cleveland Clinic plans to launch a drone delivery service to bring certain medications directly to patients’ homes, starting in 2025. 

HHS proposes info blocking 'disincentives' for hospitals, clinician groups, ACOs

Providers determined to have committed information blocking would face changes to their status in certain Medicare programs, and subsequently a hit to program payments. Enforcement would begin once the proposed rule is finalized.

Private insurer analysis uncovers geographic price variations

In a first-of-its-kind study, researchers found that the cost of patient office visits varied by region, with the highest costs typically in the upper Midwest and Southeast.
 
Fierce podcasts

Don’t miss an episode

'Podnosis': A look at Blue Shield of California's new pharmacy benefits model

In this week's episode of “Podnosis,” we explore Blue Shield of California's plan to transform its pharmacy model. This includes a shift away from the traditional PBM relationship in favor of forming partnerships with five companies: Amazon Pharmacy, Abarca, Mark Cuban Cost Plus Drugs Company, CVS Caremark, and Prime Therapeutics. 
 

Resources

Whitepaper

Research: How Automation Eases Periop Care Coordination

Research suggests how automation can ease perioperative care coordination challenges.
Webinar

Reimbursement Blueprint: 4-Step Guide to a Successful Pharma HUB

Pharmaceutical HUBs are Underutilized; Yours Doesn’t Have to Be.
 

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