CMS launches primary care pilot to expand value-based care

The Making Care Primary Model, which will begin next summer in eight states, aims to strengthen primary care delivery, particularly for safety net and small or independent organizations.

By Emily Olsen • June 9, 2023

Insurers report stable performance amid industry headwinds, but cost pressures loom

Provider cost pressures are weighing on the nation's largest insurers, with contract negotiations possibly forcing premiums higher over the next few years, according to Fitch Ratings.

By Sydney Halleman • June 7, 2023

FTC urges North Carolina legislators to drop UNC Health antitrust exemption bill

The bill’s sponsor previously told local media that it could give the nonprofit, state-owned system the chance to save struggling rural hospitals.

By Emily Olsen • June 7, 2023

Merck sues to stop Medicare negotiation of drug prices

The drugmaker’s lawsuit claims the new pricing powers granted by the Inflation Reduction Act are unconstitutional and “tantamount to extortion.”

By Christopher Newman • June 6, 2023

Friday Health Plans to shut down as state regulators step in

In a statement, the insurer said it was “unable to scale our financial infrastructure to match the pace of our growth and secure the additional capital required to run our business.”

By Emily Olsen • June 5, 2023

Biden signs debt deal, clearing path for $27B in COVID-19 clawbacks

Some of the funding is healthcare-related, and major programs like Medicaid and Medicare emerged unscathed after weeks of negotiations between Republicans and Democrats.

By Rebecca Pifer Parduhn • June 5, 2023

Tenet to pay over $29M to settle kickback allegations at Detroit Medical Center

The Department of Justice alleged two DMC hospitals offered the services of mid-level practitioners to physicians in exchange for Medicare patient referrals.

By Emily Olsen • June 2, 2023

Over half a million disenrolled amid Medicaid redeterminations so far

A KFF analysis of 11 states found many of the people who have already been removed from the Medicaid program were disenrolled for procedural reasons.

By Emily Olsen • June 1, 2023

Medicare keeps limits on Alzheimer’s drug coverage, but loosens policy

The agency will reimburse Alzheimer’s treatments if they receive full FDA approval, but plans to still require data collection via a patient registry.

By Christopher Newman • June 1, 2023

Postpartum people could lose coverage amid Medicaid redeterminations

People in some states could lose postpartum coverage 60 days after giving birth, even though health risks from pregnancy can continue for months, according to a new report from KFF.

By Emily Olsen • May 30, 2023

Healthcare provisions of the debt limit deal: COVID-19 funding clawbacks, no Medicaid work requirements

Congressional Republicans and the White House reached a deal over the weekend to raise the debt ceiling that includes healthcare policy wins for both sides of the aisle.

By Rebecca Pifer Parduhn • May 30, 2023

CVS could lose up to $1B next year from MA star ratings drop

Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed.

By Rebecca Pifer Parduhn • May 26, 2023

Two-thirds of Medicaid enrollees unaware of redeterminations, survey finds

The KFF survey found many enrollees weren’t sure whether states are now allowed to remove people from the program, and 27% wouldn’t know where to look for coverage if they were ineligible for Medicaid.

By Emily Olsen • May 25, 2023

AHIP chief executive to step down in October

Matt Eyles will depart after serving nearly five years as CEO of AHIP. The organization is launching a nationwide search for his replacement.

By Sydney Halleman • May 25, 2023

US projected to hit record-low uninsurance rate this year

But as federal aid expires, lower-income Americans — who saw the largest insurance gains during the pandemic — will likely be affected the most, according to experts.

By Rebecca Pifer Parduhn • May 24, 2023

Biden administration aims to increase Medicaid drug transparency

The notice of proposed rulemaking recommends that the CMS and states get a drug price verification survey tool and negotiate for expensive drugs under Medicaid.

By Brian T. Horowitz • May 24, 2023

House lawmakers, PBM lobby spar over committee hearing

At the latest congressional inquiry into pharmacy benefit managers, lawmakers argued the middlemen profit at the expense of patients and taxpayers.

By Rebecca Pifer Parduhn • May 24, 2023

Pharma-backed report targets federal clinics for benefiting financially from 340B drug discounts

Those grantees on average are reimbursed almost four times more for 340B prescription drugs than what they pay, and make billions in 340B drug margin, according to the report, which was funded by Gilead Sciences.

By Rebecca Pifer Parduhn • May 23, 2023

What 3 key congressional hearings last week mean for the industry

Political will seems to be rising to address drivers of growing medical costs and poor access to care, according to lawmaker comments on the Hill.

By Sydney Halleman , Rebecca Pifer Parduhn • May 19, 2023

Senate scrutinizes MA payment denials, including use of algorithms

“Insurers are in effect denying Americans necessary care in order to fatten and pad their bottom lines, and that phenomenon is unacceptable,” Sen. Richard Blumenthal, D-Conn., said at a subcommittee hearing.

By Rebecca Pifer Parduhn • May 18, 2023

FTC moves to strengthen Health Breach Notification Rule’s applicability to digital health apps

Regulators are increasingly leaning on the HBNR to crack down on the sharing of sensitive medical data, and the FTC is looking to strengthen its case.

By Rebecca Pifer Parduhn • May 18, 2023

On heels of Amgen lawsuit, FTC broadens investigation of PBMs

The regulator is probing the business practices of two more drug purchasing organizations, deepening an investigation that began last year.

By Kristin Jensen • May 18, 2023

VA renegotiates tougher EHR modernization contract with Oracle Cerner

The Department of Veterans Affairs said the new contract includes stronger performance metrics and larger credits to the VA if Oracle Cerner doesn’t meet expectations.

By Emily Olsen • May 18, 2023

House committee centers blame on PBMs for rising healthcare costs

Conversation about pharmacy benefit management consolidation dominated the hearing, with lawmakers pointing to the middlemen as drivers of high health costs.

By Sydney Halleman • May 18, 2023

Uninsured rate fell 18% during pandemic, CDC finds

The findings reflect government subsidies aimed at boosting healthcare access during the pandemic, and requirements that states keep Medicaid beneficiaries on their rolls during the public health emergency.

By Brian T. Horowitz • May 17, 2023