Payer Roundup—Kaiser executive among top earners; Medicaid official's move to CVS raises concerns; Nurses slam Anthem

Health insurance, pen and stethoscope
A former Ohio Medicaid official's jump to CVS is drawing scrutiny, plus other health insurance headlines. (Image: Getty/Minerva Studio)

Kaiser Foundation Health Plan chair, Highmark Health president among highest-paid nonprofit healthcare execs 

George Halvorson, ex-chairman of the Kaiser Family Health Plan, and William Winkenwerder, president of Highmark Health, are part of what The Wall Street Journal dubbed the nonprofit healthcare sector's "Million Dollar Club." Halvorson, who retired in 2014, earned $10,399,970 that year, according to an analysis of IRS data. Winkenwerder earned $9,793,477 in 2014. (FierceHealthcare

FTC questions delay Optum, DaVita Medical Group merger by 30 days 

The Federal Trade Commission requested additional information from DaVita, Inc. on Optum's planned acquisition of its medical group. The $4.9 billion deal will be delayed by 30 days, though the two parties still expect to close by the end of the year. DaVita and Optum did not disclose any additional information on the FTC's request. (FierceHealthcare

Medicaid official’s jump to CVS raises eyebrows

Margaret Scott, a former Ohio Medicaid official, is drawing scrutiny for jumping ship to CVS, which receives billion in pharmacy dollars from the state’s managed care programs each year. Scott started working for the company within one month of leaving the agency, and the state’s watchdog said it’s illegal for a state employee to be involved in decisions that might affect an outside business while negotiating a job with that business.

While at the department, Scott oversaw issues that could affect CVS. Melissa Ayers, a spokeswoman for the Department of Medicaid, said Friday the agency is still considering the matter but added that Scott did not have authority over the CVS pharmacy-benefit manager contracts because those were between CVS and the managed-care companies that contract with the state. (The Columbus Dispatch)

Reducing unnecessary hip and knee replacements could save billions 

Capping payments for elective joint replacements could save Medicare billions, research shows. About 505,000 hip replacements and 723,000 knee replacements were performed in the United States in 2014 and they cost more than $20 billion, according to an article published the Journal of the American Medical Association. Jonathan Fielding, M.D., a co-author of the article and founder and co-director of the Center for Health Advancement, said creating decisions aids to inform patients about alternatives and risks would help avoid unnecessary procedures. (FierceHealthcare)

Maryland hospital payment overhaul saves millions

Maryland’s system of pushing hospitals to lower admissions has added up to hundreds of millions of dollars in savings, a new report shows. Since 2014, the state caps hospitals’ revenue each year, letting them keep the difference if they reduce inpatient and outpatient treatment while maintaining care quality. Per capita hospital spending by all insurers has grown by less than 2% a year in Maryland, below the economic growth rate, defined four years ago as 3.58% annually, a key goal for the program. (FierceHealthcare)

American Association of Nurse Anesthetists criticizes Anthem's anesthesia policy 

The American Association of Nurse Anesthetists called a recent policy change from Anthem—which deemed that monitored anesthesia care is "not medically necessary"—a "dangerous and reckless policy that jeopardizes the safety and well-being of millions of patients, all in an effort to cut costs and increase profits." Anthem has taken plenty of heat from provider groups over the change, which was announced last month.  

In addition, one of the authors of the study on which Anthem based its changes has come out against the policy. Steven I. Rosenfeld, M.D., a Del Rey, Florida-based ophthalmologist and senior author on the study, said in a post published in the American Academy of Ophthalmology's EyeNet Magazine that Anthem "misinterpreted our findings and made statements directly contrary to our conclusions." (StatementPost)

Maryland bills aim to save individual insurance market

Maryland is moving forward with legislation to prop up its individual market exchange. The state’s House of Delegates passed the second of two bills Monday that is aimed at keeping rates down over the next year. The bills would use about $340 million that health insurance companies won’t have to pay due to last year’s tax overhaul. The state Senate has also advanced similar legislation. Once passed in both chambers, the legislation will head to the governor’s desk. (Associated Press)

CMS: Medicare will cover Next Generation Sequencing tests for cancer patients 

The Centers for Medicare & Medicaid Services announced that Medicare will cover diagnostic tests using Next Generation Sequencing. These tests, which are primarily given to patients with advanced cancer, can be used to identify gene mutations that could lead to additional treatment options. CMS Administrator Seema Verma said that agency wants to ensure Medicare beneficiaries with cancer have "expanded access and expanded coverage" for diagnostic tests. (Announcement)

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