Payer
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Tenet, CVS and Cigna lead Healthcare Dive's JPM20 coverage
Molina and Centene also touted their organic growth potential at the annual investor conference drawing some of the biggest industry names.
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FTC commissioner pledges hard line on hospital mergers
Lobbyists and legislators also spoke at a Council for Affordable Health Coverage forum, noting a surprise billing ban is still on the table for Congress despite disagreements over the policy to achieve it.
By Shannon Muchmore • Jan. 17, 2020 -
Deep DiveKey 2020 trends for payers and providers
No matter who wins the White House come November, healthcare experts say the push to reimburse providers for value and the aim for greater transparency surrounding prices will keep moving ahead.
By Samantha Liss • Jan. 17, 2020 -
MedPAC finds 340B effect on pricing 'modest,' going against pharma critique
The commission's report provides some new ammunition in the ongoing battle between pharmaceutical companies and nonprofit disproportionate share hospitals over the future of the 340B drug discount program.
By Rebecca Pifer • Jan. 17, 2020 -
CVS, Cigna execs tell JPM20 they're ready for a contentious election year
The payer officials took to the stage at the annual investor conference in San Francisco, speaking on the future of M&A and reflecting on what's sure to be a year focused on policy and politics.
By Rebecca Pifer , Shannon Muchmore • Jan. 15, 2020 -
Hospitals, insurers urge Supreme Court to hear ACA case to avert havoc
Lobbying groups said the case could take years to play out without the high court stepping in to hear arguments now.
By Samantha Liss • Jan. 15, 2020 -
UnitedHealth reports nearly $14B in 2019 profit
The company beat forecasts on Q4 earnings, though revenues of $60.9 billion were slightly lower than Wall Street expectations.
By Rebecca Pifer • Jan. 15, 2020 -
LabCorp, Quest push for M&A-driven growth despite difficulties closing deals
"It’s still a very fragmented marketplace. There’s plenty of opportunity for us to consolidate it," Quest CEO Steve Rusckowski said.
By Nick Paul Taylor • Jan. 15, 2020 -
Deep DiveWill more employers get off the healthcare bench in 2020?
"At the end of the day, employers have to put their hands on the steering wheel as purchasers of healthcare," Suzanne Delbanco, executive director of Catalyst for Payment Reform, said.
By Rebecca Pifer • Jan. 14, 2020 -
Cigna links up with upstart Oscar for small business health insurance
New York City-based Oscar has won some praise for customer service, but also criticism for small provider networks.
By Rebecca Pifer • Jan. 14, 2020 -
JPM20: Rivals Molina, Centene pitch investors on organic growth
"I'll repeat this countless numbers of times this afternoon: Our first priority is to grow the business organically. It is the most efficient use of capital," Molina CEO Joseph Zubretsky said as the annual investor conference kicked off.
By Samantha Liss • Jan. 14, 2020 -
Supreme Court to take on PBM rate regulation
A federal appeals court previously ruled in favor of pharmacy benefit managers, finding federal law preempts states from regulating their rates.
By Samantha Liss • Jan. 13, 2020 -
The government recovered $3B in fraud last year. Nearly 90% was from healthcare
It marks the 10th consecutive year the DOJ has recouped more than $2 billion from False Claims Act settlements and judgments for HHS.
By Rebecca Pifer • Jan. 10, 2020 -
CVS, Mayo, Tenet among healthcare companies to watch at #JPM20
As many as 9,000 attendees across 450 public and private companies are expected to make an appearance in San Francisco at one of the most influential conferences of the year.
By Samantha Liss , Shannon Muchmore , Rebecca Pifer • Jan. 10, 2020 -
Individual market appears stable despite lack of mandate penalty
Claims costs in the first nine months of 2019 grew and average hospital time dipped, indicating the market didn't have disproportionately sicker patients, according to the Kaiser Family Foundation.
By Shannon Muchmore • Jan. 08, 2020 -
Molina expands Illinois footprint with $50M acquisition
The buy of NextLevel Health Partners, if approved, would give Molina more members in Cook County.
By Samantha Liss • Jan. 08, 2020 -
DOJ joins whistleblower suit against Indiana system for alleged Stark violation
Community Health Network is accused of submitting as many as hundreds of thousands of fraudulent claims to Medicare and other federal programs from at least 2008 to 2017.
By Rebecca Pifer • Jan. 08, 2020 -
CMS proposes using more encounter data for MA risk adjustment
The mix of encounter data used to calculate payments would go up to 75% next year under the proposed regulation. Payers have railed against previous increases, saying the information is inaccurate and unreliable.
By Shannon Muchmore • Jan. 07, 2020 -
Ex-Anthem exec Brad Smith appointed head of CMS innovation center
Smith, previously co-founder and CEO of palliative care company Aspire Health, replaces outgoing CMMI head Adam Boehler.
By Rebecca Pifer • Jan. 07, 2020 -
Supreme Court says ACA opponents have until Friday to respond to motion to expedite
The court set the deadline Monday after a push by the law's supporters to have the case heard before this year's presidential election.
By Samantha Liss • UPDATED: Jan. 7, 2020 at 10:35 a.m. -
In win for big payers, appeals court sides with HHS in risk adjustment case
AHIP and the Blues argued it would be inconceivable to come up with an entirely new formula for the payments created under the Affordable Care Act.
By Samantha Liss • Jan. 03, 2020 -
Pfizer, AbbVie and Gilead among drugmakers boosting prices to start 2020
List prices rose on some of the top-selling medicines in the U.S., including Humira, Opdivo, Prevnar 13 and Biktarvy.
By Andrew Dunn • Jan. 02, 2020 -
ACA 2020 enrollment stable but dips slightly
CMS attributed the decline to a few factors, including a strong economy that may have moved more people into job-based coverage and states expanding Medicaid eligibility.
By Ron Shinkman • Dec. 23, 2019 -
Sutter to pay $575M, change contracting practices in antitrust settlement
Pending approval, the deal bars the dominant Northern California system from using all-or-nothing contracts and stops certain bundling practices.
By Shannon Muchmore • Dec. 20, 2019 -
MA value-based plan enrollment tripling for 2020
CMS also moved to fold hospice care into Medicare Advantage, a cost-cutting step industry has expected for a while.
By Rebecca Pifer • Dec. 20, 2019
