Payer


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    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 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
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    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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    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 June 22, 2022
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    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
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    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 June 21, 2022
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    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 June 17, 2022
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    Opinion

    Expiration 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 June 16, 2022
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    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 June 15, 2022
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    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 June 15, 2022
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    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 June 15, 2022
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    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
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    Deep Dive

    Despite 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 June 13, 2022
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    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 June 7, 2022
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    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
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    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 June 3, 2022
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    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 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 June 1, 2022
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    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 May 31, 2022
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    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 May 26, 2022
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    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 May 26, 2022
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    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
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    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
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    Sponsored by ProviderTrust

    Travel 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