Payer


  • A picture from chest-up of Bernie Sanders speaking to reporters. The top of the US capitol building is visible behind him.
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    Anna Moneymaker/Getty Images via Getty Images

    Bernie Sanders poised to lead Senate health committee

    The longtime proponent of universal healthcare is set to become chair of the Health, Education, Labor and Pensions Committee. Sen. Bill Cassidy, R-La., is in line to be the committee’s ranking member.

    By Nov. 28, 2022
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    Permission granted by Zipari
    Sponsored by Zipari

    Health insurance customer experience starts at open enrollment

    Why health plan consumer experience matters; from the perspective of a stressed-out son.

    By Maryann Waugh, Director of Content and Research • Nov. 28, 2022
  • Explore the Trendline
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    Yujin Kim/Healthcare Dive
    Trendline

    Payer/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
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    Sam Edwards via Getty Images

    Centene continues to sell ancillary business units

    The sale of Magellan Specialty Health is the latest divestiture in Centene’s plan to sell non-core assets as part of a long-term strategy to improve the company’s profit margin.  

    By Nov. 23, 2022
  • a picture of a red stethoscope on top of a US billed money.
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    Adeline Kon/Healthcare Dive/Healthcare Dive

    Lawmakers object to latest surprise billing rule, call for changes

    House Ways and Means Committee leaders “are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before,” they wrote in a letter to regulators last week.

    By Nov. 22, 2022
  • HHS Secretary Xavier Becerra speaks to reporters.
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    HLTH22

    HHS to look at MA risk adjustment as upcoding in spotlight

    Regulators have considered changing how they calculate patient risk and provider reimbursement, work that the HHS head said is continuing.

    By Nov. 17, 2022
  • Xavier Becerra sits on a couch onstage at HLTH.
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    Rebecca Pifer/Healthcare Dive
    HLTH22

    Divided Congress after midterms will allow HHS to execute on policy priorities, Becerra says

    The department will focus on implementing drug price negotiation in Medicare and surprise billing regulations, according to the secretary.

    By Nov. 16, 2022
  • The main stage at HLTH22
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    Rebecca Pifer/Healthcare Dive
    HLTH22

    Elevance plans to continue aggressive M&A, CEO says

    CEO Gail Boudreaux said the insurer plans to grow "very aggressively" into adjacent care services.

    By Nov. 15, 2022
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    HLTH22

    Maven raises $90M, fueling push into Medicaid, CMO says

    Roadblocks for the startup include shifting requirements state-by-state and historically low margins in Medicaid.

    By Nov. 15, 2022
  • Male patient using tablet computer with female doctor in clinic
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    Cavan Images/Stock.adobe.com

    Medical group asks Congress to offset Medicare payment cuts

    The Medical Group Management Association wants Congress to take action to help physician practices by the end of the year.

    By Nov. 15, 2022
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    Jack Taylor via Getty Images

    Nearly 1 in 4 gig workers lacks health insurance, survey finds

    A majority of those workers cited affordability as the main barrier to getting coverage, according to a poll from insurance broker Stride Health.

    By Nov. 15, 2022
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    Scott Eisen via Getty Images

    Cigna’s MDLive will add chronic care program to virtual primary care plans

    Initially, the program will be available for patients with hypertension, but will expand throughout the year to other common chronic conditions.

    By Nov. 14, 2022
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    Fotolia

    Bright Health ceases MA operations in Florida in latest business cut

    The newest reduction for the insurtech comes less than a month after Bright announced it was leaving the Affordable Care Act exchanges and slashing its Medicare Advantage footprint to just Florida and California.

    By Nov. 10, 2022
  • An illustration of a large dollar coin with medical supplies flying in the foreground is positioned on an analysis tracking chart background.
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Profits continue to climb for payers as possible recession looms

    Despite talk of a recession, all major insurers expect a rosier end to 2022 than previously predicted. On the other hand, profits fell for large hospital operators faced with pricier labor and lower volumes.

    By Nov. 9, 2022
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Elevance Health to acquire specialty pharmacy BioPlus

    BioPlus will complement the payer’s existing pharmacy benefit manager, IngenioRx, providing patients with specialty drugs and a whole-health approach.

    By Nov. 9, 2022
  • Walgreens VillageMD primary care clinic
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    What’s in it for Evernorth? Cigna’s health services arm invests $2.5B in VillageMD-Summit

    The deal could have major ramifications for Evernorth’s push to value-based care in the commercial sector, according to Cigna executives and analysts.

    By Nov. 9, 2022
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    FatCamera via Getty Images
    Sponsored by Cognizant

    Tomorrow’s healthcare industry leaders will be masters of agility and innovation — a product mindset will show them the way

    Though healthcare hasn’t always been considered a hotbed of innovation; new market pressures are pushing payer and provider organizations to become more flexible and agile than ever before.

    Nov. 7, 2022
  • An illustration of a hospital and a medical corporate building pieced together like a puzzle.
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Cigna faces questions about M&A strategy amid ‘arms race’ for deals

    One analyst asked whether not pursuing deals will pose a disadvantage in future years. CEO David Cordani said he is open to M&A but does not think acquisitions are a “silver bullet.”

    By Nov. 3, 2022
  • A brick wall with a red CVS Pharmacy sign.
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    Justin Sullivan via Getty Images

    CVS agrees to pay $5B to resolve opioid-related lawsuits

    Walgreens and Walmart also have reportedly reached deals. If they become final, it could end much of the yearslong litigation over the pharmacy companies’ role in the opioid epidemic.

    By Nov. 2, 2022
  • A picture of the exterior of the US Department of Health and Human Services. In front of the building is a black sign designating the building's name.
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    Alex Wong via Getty Images

    CMS to ease Medicare ACOs into risk models in bid to boost participation

    Beginning in January 2024, ACOs that don’t have experience with performance-based risk will be able to stay in a one-sided risk arrangement for up to seven years before transitioning to two-sided risk.

    By Nov. 2, 2022
  • Medical building for patients seeking outpatient care.
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    EyeMark via Getty Images

    CMS finalizes requirements for rural emergency hospital designation

    The conditions of participation include maintaining an average length of stay of no more than 24 hours and having emergency care available 24 hours a day, seven days a week.

    By Nov. 2, 2022
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    CMS

    Humana expects Medicare Advantage enrollment to grow almost 9% in 2023

    Executives said better benefits are attracting more members. For certain plans, Humana members have an allowance for healthy foods, over the counter items, transportation, health supplies, rent and utilities.

    By Nov. 2, 2022
  • A man being helped by a home health care aide
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    Phynart Studio via Getty Images

    Cigna partners with in-home primary care provider Heal

    The provider, which focuses on care for seniors, is collaborating with Cigna to offer house calls and remote monitoring to Medicare Advantage customers in four states.

    By Nov. 1, 2022
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    CMS

    Seniors to see reduced delays in Medicare coverage under new Biden admin policies

    Under the changes, traditional Medicare coverage will kick in the month immediately after enrolling.

    By Oct. 31, 2022
  • UnitedHealthcare latest payer to expand ACA reach with 4 new states for 2023

    The payer has been steadily ratcheting up its presence on the Affordable Care Act exchanges after dramatically reducing its footprint in 2017.

    By Oct. 28, 2022
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    Fotolia

    Molina’s contract wins will have ‘profound impact’ on company, CEO says

    The string of Medicaid contracts amount to $5.8 billion in additional annual premium revenue, according to CEO Joe Zubretsky.

    By Oct. 27, 2022