Payer
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Alamy
Cigna’s new chief medical officer starts as other execs depart the company
Dr. Amy Flaster, Cigna Healthcare’s chief medical officer since last year, is stepping up as CMO of the whole enterprise. At the same time, Cigna’s chief health officer and a business improvement executive are hitting the road.
By Rebecca Pifer • Nov. 6, 2025 -
Spencer Platt via Getty Images
Humana confident in Medicare Advantage growth despite plan generosity muddling margin recovery
The Medicare giant likes what it’s seen in the first two weeks of open enrollment. But there are steps it can take if membership growth starts getting out of hand, executives said.
By Rebecca Pifer • Nov. 5, 2025 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Permission granted by Aspen Institute
Legislators object to proposed CMS payment changes for diabetes tech
In a letter to CMS Administrator Dr. Mehmet Oz, diabetes caucus leaders raised concerns that the agency’s proposals will reduce access to glucose monitors and insulin pumps.
By Elise Reuter • Nov. 4, 2025 -
Alamy
UnitedHealthcare pays Optum doctors more than other doctors: study
Researchers said the results suggest UnitedHealth may be sidestepping government rules meant to keep a lid on exorbitant payer profits. UnitedHealth said the study was “flat-out wrong.”
By Rebecca Pifer • Nov. 4, 2025 -
Al Drago via Getty Images
Health groups urge passage of bill to ease Medicare pay cuts for tests
More than 30 organizations, including AdvaMed and the American Clinical Laboratory Association, are pushing for a permanent legislative solution to stop looming Medicare payment cuts for diagnostic tests.
By Susan Kelly • Nov. 3, 2025 -
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Medicare finalizes controversial cut to specialty care next year
The CMS finalized the Medicare physician fee schedule for 2026 on Friday, one day before the statutory deadline. It includes an overall payment hike and a few policies that are deeply unpopular with specialists.
By Rebecca Pifer • Updated Nov. 4, 2025 -
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Federal ACA enrollment kicks off without action on subsidies
Millions of Americans are facing steep price hikes for Affordable Care Act coverage while Congress dithers over the issue. Experts say there’s not as much time to act as legislators may believe.
By Rebecca Pifer • Nov. 1, 2025 -
Alamy
Cigna’s 2026 pharmacy profits could be dampened by transition to rebate-free model
Overall, Cigna expects earnings to grow next year after posting a solid third quarter. But investments in a new PBM model and discounted contracts for some big clients could lower Express Scripts’ profitability, executives said.
By Rebecca Pifer • Oct. 30, 2025 -
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Voters blame insurers for medical debt: poll
More than 60% of respondents said insurance companies are most at fault for medical debt, compared with just 9% who blamed hospitals, according to a survey by nonprofit Undue Medical Debt.
By Emily Olsen • Oct. 29, 2025 -
Joe Raedle via Getty Images
CVS hikes 2025 guidance despite goodwill impairment charge on healthcare delivery
The healthcare giant beat Wall Street expectations in the third quarter, but reported a net loss after recording a $5.7 billion charge linked primarily to decelerating clinic growth at Oak Street Health.
By Emily Olsen • Oct. 29, 2025 -
Alamy
Centene posts $6.6B loss on massive value writedown
The goodwill impairment charge is meant to realign Centene’s value on its own books with its value in the market, which has plummeted this year. Still, Centene upped its earnings outlook for 2025.
By Rebecca Pifer • Oct. 29, 2025 -
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National payers OK on price transparency compliance: Turquoise Health
The company has started to score insurers on their success in making rate data available online. Large payers tend to do better than their smaller peers.
By Rebecca Pifer • Oct. 29, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth maps path back to Wall Street’s good graces
The healthcare giant beat Wall Street expectations in the third quarter and raised its 2025 earnings guidance, albeit modestly.
By Rebecca Pifer • Oct. 28, 2025 -
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Surprise Billing
High volume of surprise billing disputes are ineligible for arbitration, insurers allege
Plans found 39% of claims submitted to independent dispute resolution last year were actually ineligible for the process, but arbiters themselves caught only 17% of improper cases, according to AHIP and the BCBSA.
By Rebecca Pifer • Oct. 27, 2025 -
Courtesy of Express Scripts
Cigna’s Express Scripts to transition away from rebate drug model
The massive PBM also said it will move to a cost-plus reimbursement model for in-network pharmacies. The moves come as the controversial drug middlemen attempt to lessen regulatory scrutiny.
By Rebecca Pifer • Oct. 27, 2025 -
Getty Images
CMS calls back furloughed employees to help with Medicare, ACA enrollment periods
Roughly 3,000 employees went back to work on Monday, funded by user fees as the shutdown drags into its fourth week.
By Rebecca Pifer • Oct. 24, 2025 -
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Ballad Health sues UnitedHealth for Medicare Advantage ‘manipulation’
The Appalachian system said it is turning to the courts as a last resort after failing to resolve years of payment and patient care issues.
By Rebecca Pifer • Oct. 24, 2025 -
Permission granted by Optum
Optum taps its second CFO in 6 months
It’s the latest management shakeup at UnitedHealth as the company attempts to shore up investor confidence.
By Rebecca Pifer • Oct. 24, 2025 -
Alamy
Molina slashes 2025 profit guidance again on ACA woes
Molina’s profit in the third quarter plummeted as the insurer was hit with an increase in marketplace medical costs that one analyst called “staggering.”
By Rebecca Pifer • Oct. 23, 2025 -
Courtesy of HLTH 2025
HLTH25Top RFK aide lashes out against healthcare industry for profiting off of illness
Calley Means stopped short of accusing hospitals, insurers and drug companies of actively working to keep Americans sick, but said it was an "economic fact" that the companies benefit financially when people are ill.
By Susanna Vogel • Oct. 22, 2025 -
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‘A quiet alarm bell going off’: Job-based family coverage hits $27K annually
Premium increases are outpacing wage growth and general inflation at a time of intense focus on healthcare affordability, according to new research from KFF.
By Rebecca Pifer • Oct. 22, 2025 -
Permission granted by Optum
HLTH25
Optum launches AI system to speed medical claims
Optum Real allows providers to receive information about patients’ health benefits in real time, the company said.
By Emily Olsen • Oct. 22, 2025 -
Emily Olsen/Healthcare Dive/Healthcare Dive
HLTH25Medical billing firm Cedar launches Medicaid enrollment tool as cuts loom
The tool, which aims to help patients enroll in and maintain coverage, comes as healthcare braces for major cuts to the safety-net insurance program.
By Emily Olsen • Oct. 21, 2025 -
Alamy
Elevance outperforms in third quarter but warns of Medicaid challenges
The Indianapolis-based company is the first major insurer to release earnings this cycle. Elevance did well in the quarter, but hinted that profits could be constrained in 2026.
By Rebecca Pifer • Oct. 21, 2025 -
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Opinion
Beyond one-size-fits-all: How ICHRA empowers employees and employers
ICHRA plans, a nascent form of health coverage, are gaining traction, argues an executive of Centene subsidiary Ambetter Health.
By Alan Silver • Oct. 16, 2025
