Payer


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    Molina loses Medicaid contract in Virginia

    It’s the second recent Medicaid state loss for Molina, despite executives expressing confidence about the insurer’s ability to retain contracts.

    By March 1, 2024
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    Elevance launches weight management program, including GLP-1 monitoring

    Elevance joins a growing list of insurers expanding their weight management offerings amid soaring demand for GLP-1 drugs.

    By Feb. 28, 2024
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    Trendline

    Social determinants of health

    The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.

    By Healthcare Dive staff
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    Courtesy of UnitedHealth Group
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    UnitedHealth under antitrust investigation by DOJ: reports

    Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.

    By Feb. 28, 2024
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    Alex Wong via Getty Images
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    Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects

    Medicare Advantage payment per month per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.

    By Feb. 27, 2024
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    Colin Campbell/Healthcare Dive
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    State attorneys general urge PBM reform

    The letter, sent on behalf of 39 state attorneys general to leaders in Congress, comes as lawmakers consider legislation to regulate the pharmacy middlemen.

    By Feb. 23, 2024
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    Medicare Advantage plans provide less intensive post-acute care, study finds

    The research found no differences in 30-day hospital readmissions or mortality, but the study’s authors said more analysis on patients’ long-term functioning was needed.

    By Feb. 21, 2024
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    Alex Wong via Getty Images
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    CMS finalizes rule to cut Medicaid DSH payments for some hospitals

    Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.

    By Updated Feb. 22, 2024
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    No Surprises implementation created uptick in in-network claims: Fair Health

    From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.

    By Feb. 20, 2024
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    Deep Dive

    Insurers brace for continued Medicare Advantage medical costs

    The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.

    By Feb. 20, 2024
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    Disputes over surprise billing continue to soar, new CMS data shows

    Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.

    By Feb. 16, 2024
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    CFO Editorial Staff
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    SCAN Group, CareOregon abandon merger plans

    The insurers have dissolved their merger a little over a year after it was announced amid rising criticism from politicians and the public. 

    By Feb. 15, 2024
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    Blue Cross of Louisiana halts sale to Elevance

    It's the latest setback for the $2.5 billion deal, which was proposed early last year but has struggled to close amid a lack of buy-in from state regulators. 

    By Feb. 15, 2024
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    erdikocak via Getty Images
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    Private equity deals in Medicare Advantage decline, report finds

    High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project. 

    By Feb. 14, 2024
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    Stock via Getty Images
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    Humana sued over alleged 340B underpayments in Medicare Advantage

    Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.

    By Feb. 13, 2024
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    Elevance lays off more employees

    The health insurer has quietly laid off thousands of employees since September, according to sources.

    By Feb. 13, 2024
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    FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance

    The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.

    By Feb. 12, 2024
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    Molina’s redeterminations losses reach 500K members

    As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.

    By Feb. 8, 2024
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    UnitedHealth COO Dirk McMahon to retire

    McMahon is leaving after two decades at the insurer.

    By Feb. 8, 2024
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    CVS cuts 2024 outlook on Medicare Advantage caution

    The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.

    By Feb. 7, 2024
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    Gerenme via Getty Images
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    AHA calls for more payer oversight in No Surprises dispute resolution

    In comments on a proposed rule, the American Hospital Association argued regulators haven’t fully addressed how they’ll handle oversight for some situations, like when an insurer fails to pay after a dispute determination.

    By Feb. 7, 2024
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    Samantha Liss/Healthcare Dive
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    Centene echoes Humana’s concerns about proposed MA rate drop

    On the insurer’s earnings call, analysts peppered Centene with questions about its Medicare Advantage business until its CFO attempted to change the subject.

    By Feb. 6, 2024
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    Q&A

    BeMe’s CEO Nicki Tessler on digital behavioral health programs and payer partnerships

    Depression and anxiety climbed among teens during the COVID-19 pandemic. Nicki Tessler, CEO and cofounder of BeMe Health, breaks down solutions.

    By Feb. 5, 2024
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    Humana flags potential MA funding dip if proposed rate notice finalized

    Despite the uncertainty, the insurer reaffirmed its earnings outlook for 2025.

    By Feb. 5, 2024
  • A sign advertises Cigna's free health screenings as the Cigna HIT tour takes to the beach on May 31, 2019 in Virginia Beach, Virginia.
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    Cigna is still interested in Medicare

    The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.

    By Feb. 2, 2024
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    Medicare Advantage plans could see rates dip slightly in 2025

    The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.

    By Feb. 1, 2024