Payer
-
milehightraveler/iStock/Getty Images Plus via Getty Images
Colorado first state to launch public option via federal waiver
Through the waiver granted by the CMS on Thursday, Colorado can use federal funds to set up a government-run health plan, a long-held progressive healthcare goal.
By Rebecca Pifer • June 24, 2022 -
SCOTUS rejects UnitedHealth appeal of Medicare Advantage overpayment rule
The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments.
By Susan Kelly • June 22, 2022 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/Provider relationships
As M&A intensifies and companies are more likely to embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Zolnierek via Getty Images
Molina to pay $4.6M to settle False Claim Act allegations
The settlement comes after whistleblowers brought a suit against Molina and a former subsidiary, alleging care at Massachusetts-based behavioral health clinics was given by inadequately trained and unsupervised clinicians.
By Sydney Halleman • June 22, 2022 -
Thomas Barwick via Getty Images
Medicare data errors impede health equity efforts, OIG says
The ability to assess health disparities and improve care delivery in communities of color hinges on the quality of race and ethnicity data that is currently falling short, the report said.
By Susan Kelly • June 21, 2022 -
E.A. Crunden/Healthcare Dive
Washington ups pressure on PBMs with more aggressive FTC policy, congressional ask for GAO study
The Federal Trade Commission has voted unanimously to adopt a policy statement to more closely examine fees and rebates paid to PBMs in exchange for preferred coverage of their drugs from payers.
By Rebecca Pifer • June 21, 2022 -
Permission granted by CVS Health
CVS appoints new chief strategy officer
Prior to joining CVS, Violetta Ostafin was at insurance company Aon, and also worked as a managing director and partner at Boston Consulting Group.
By Rebecca Pifer • June 17, 2022 -
Dollar Photo Club
OpinionExpiration of healthcare subsidies will have domino effect, leading to higher prices and increased medical debt
Millions of Americans will experience dramatic price increases, become uninsured and likely accrue medical debt, GetInsured’s Heather Korbulic argues.
By Heather Korbulic • June 16, 2022 -
Anthem launches Wellpoint health plan, Carelon health services brands
The payer announced the move, meant to streamline its brand portfolio and reduce complexities, ahead of a corporate rebranding scheduled for later this month.
By Rebecca Pifer • June 16, 2022 -
Samantha Liss for Healthcare Dive
Centene settles with New Mexico on PBM overcharging allegations
Centene has agreed to pay nearly $250 million to settle allegations in six states. The insurer plans to no longer operate a pharmacy benefit management firm in-house.
By Samantha Liss • June 15, 2022 -
Sean Pavone Photo via Getty Images
Hospitals win SCOTUS case against 340B rate cuts
The Justices were unanimous in their decision, with Justice Brett Kavanaugh writing it was “a straightforward case.”
By Shannon Muchmore • June 15, 2022 -
Fotolia
Finances of older Americans being dinged by high health costs, survey finds
It’s the latest picture of how exorbitant healthcare costs in the U.S. are increasingly impacting the financial stability of Americans, especially older adults.
By Rebecca Pifer • June 15, 2022 -
CMS
Most Medicare Advantage enrollees like their plans, survey finds
As the program has soared in popularity, it has attracted the attention of federal investigators, including an HHS OIG report finding inappropriate prior authorization and claims denials.
By Susan Kelly • June 14, 2022 -
iStock via Getty Images
Deep DiveDespite rosier trust fund outlook, time running out to stabilize Medicare funding, researchers warn
Though it’s tempting to interpret the recent Medicare trustees report as good news, academics are arguing lawmakers can’t wait until hospital trust fund insolvency is imminent before taking action to bolster the program.
By Rebecca Pifer • June 13, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC launches investigation into PBMs; CVS, UnitedHealth, Cigna and more hit with requests for data
Pharmacy groups cheered the news, which reversed a vote earlier this year by FTC commissioners not to investigate PBMs' pricing and contractual practices.
By Rebecca Pifer • June 7, 2022 -
Permission granted by Pear Therapeutics
Pear sets out payer strategy as it seeks to quadruple prescriptions of digital therapeutics
Pear shared real-world data that linked its digital therapeutic for substance use disorders to an estimated $3,591 reduction in per-patient costs.
By Nick Paul Taylor • June 7, 2022 -
SARINYAPINNGAM via Getty Images
Payers to return $1B to enrollees after record years of rebates, KFF says
The amount reflects the third-straight year of large insurer rebates as payers experienced high profits from the COVID-19 pandemic.
By Sydney Halleman • June 3, 2022 -
iStock via Getty Images
Trustees' report shows additional breathing room for Medicare solvency, though concerns remain
Stronger-than-expected economic recovery from COVID-19 pushed back Medicare's go-broke date by two years, though budget hawks are warning the sunnier outlook might rely on outdated assumptions.
By Rebecca Pifer • June 3, 2022 -
PBM practices are keeping consumers from generics savings, white paper finds
Consumers are overpaying for generic drug prescriptions by as much as 20% due to pharmacy benefit manager practices like copay clawbacks and spread pricing, researchers found.
By Rebecca Pifer • June 1, 2022 -
Permission granted by Biogen
Medicare premiums will remain unchanged after Aduhelm price cut spurs review
The HHS Secretary had hoped premiums could be cut for seniors sooner rather than later but there are "legal and operational hurdles" to changing premiums midyear, according to a statement released Friday.
By Samantha Liss • May 31, 2022 -
Adobe Stock
Rollback of pandemic protections to test Medicaid managed care organizations
At question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.
By Samantha Liss • May 26, 2022 -
Permission granted by Clover Health
Clover Health appoints Scott Leffler as CFO following role turnover
Leffler joins the nine-state insurtech from sterilization and lab services provider Sotera, where he was CFO for five years.
By Rebecca Pifer • May 26, 2022 -
iStock via Getty Images
Study: Pre-deductible HSA coverage of chronic condition meds won't jack up premiums
A 2019 IRS notice expanded the list of medications and health services that some plans may cover pre-deductible, including those used to treat chronic conditions.
By Ryan Golden • May 25, 2022 -
North Carolina Republicans draft Medicaid expansion bill
The proposal, which signals growing support for expansion among state lawmakers after years of opposition, would add 600,000 low-income adults to the safety net insurance program.
By Susan Kelly • May 25, 2022 -
Fotolia
AHA urges DOJ to probe Medicare Advantage plans that deny care
The hospital lobby is pushing the Justice Department to punish Medicare Advantage organizations that routinely deny coverage to beneficiaries.
By Susan Kelly • May 23, 2022 -
iStock/gorodenkoff
Sponsored by ProviderTrustTravel nurses: a challenging population for credentialing and monitoring
Travel nursing continues to rise – how are you monitoring license verifications across state lines?
May 23, 2022
