Payer


  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    UnitedHealth’s Optum Rx unveils new drug pricing model

    Major pharmacy benefit managers are rolling out a flurry of ostensibly transparent and cost-effective models to retain clients and placate scrutiny over their role in rising drug costs.

    By May 21, 2024
  • Sen Ron Wyden sits behind a wooden podium with a microphone.
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    Sarah Silbiger / Stringer via Getty Images
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    Senate Finance Committee tackles Medicare physician pay reform

    On Friday, the committee released a white paper proposing Medicare adjust doctor reimbursement to account for inflation, a key goal for physician lobbies.

    By May 20, 2024
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    RossHelen via Getty Images
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    Trendline

    Social determinants of health

    The focus on social determinants of health has only increased because of the impacts of the pandemic, with payers and providers trying to new ways to address the issues.

    By Healthcare Dive staff
  • An aerial view of the capital statehouse grounds in Topeaka Kansas USA
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    ChrisBoswell via Getty Images
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    Kansas jilts CVS in new Medicaid contract awards

    Kansas kicked CVS to the curb in favor of an Elevance plan, while awarding contracts to incumbents UnitedHealth and Centene. The contracts are worth roughly $4 billion annually.

    By May 15, 2024
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    FangXiaNuo via Getty Images
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    Hospitals charged employers and insurers 254% more than Medicare in 2022: study

    Hospitals with larger market shares were among the worst offenders, the Rand Corporation found.

    By May 14, 2024
  • Humana CEO Bruce Broussard
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    Michael Loccisano / Staff via Getty Images
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    Humana CEO Bruce Broussard to depart July 1

    At that time, current Chief Operating Officer Jim Rechtin will take the reins of the health insurer, which is struggling with challenges in Medicare Advantage.

    By May 14, 2024
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    400tmax via Getty Images
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    Deep Dive

    Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1

    All major payers saw elevated utilization but only an unprepared few struggled with the trend, the Change Healthcare cyberattack caused minimal financial fallout and a new D-SNP rule opens the door to a Medicare growth opportunity.

    By May 13, 2024
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    yavdat via Getty Images
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    CHS sues MultiPlan for allegedly colluding to lower provider reimbursement

    It’s the third lawsuit filed against MultiPlan by a health system in under a year.

    By May 10, 2024
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    Alex Wong / Staff via Getty Images
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    CMS proposes mandatory kidney care model with financial risk for hospitals

    The model, if finalized, will test whether putting hospitals on the hook for kidney transplant access and quality might improve the nation’s shoddy system of organ procurement and transplantation.

    By May 9, 2024
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    dventtr via Getty Images
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    MA health assessments contribute to inflated coding intensity: study

    Some limits on how the assessments are used might be justified to ensure Medicare Advantage plans aren’t overpaid, researchers wrote. 

    By May 8, 2024
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    Spencer Platt via Getty Images
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    Medicare go-broke date extended to 2036, but warning bells continue ringing

    The Medicare trustees’ new projection for insolvency is five years later than previous forecasts, but budget hawks warned action is still needed to shore up the insurance program’s finances.

    By May 7, 2024
  • Cigna's logo is seen on a door.
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    Julia Rendleman via Getty Images
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    Cigna writes down VillageMD investment amid shrinking value

    Walgreens’ decision to slash VillageMD’s clinical footprint has reverberated to the financial accounts of the primary care chain’s minority owner — Cigna.

    By May 2, 2024
  • A view from below of the CVS sign on the center of a building, with a vertical blue HealthHub sign to its right.
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    Mario Tama via Getty Images
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    CVS acquires Medicare Advantage broker Hella Health

    The acquisition comes amid rising regulatory scrutiny of insurance brokers and notable turbulence in MA.

    By , May 1, 2024
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    Mario Tama via Getty Images
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    CVS slashes 2024 outlook — again — as Medicare seniors drive spending

    Runaway inpatient spending in particular caused CVS’ insurance costs to snowball after returning “to patterns we have not seen since the start of the pandemic,” its CFO said.

    By May 1, 2024
  • Andrew Witty attends the World Economic Forum annual meeting in Davos, Switzerland, Jan. 19, 2017.
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    Ruben Sprich/Reuters

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    Change Healthcare cyberattack

    Change Healthcare, compromised by stolen credentials, did not have MFA turned on

    Failing to turn on multifactor authentication, a common cybersecurity safeguard, “underscores pure negligence on the part of UnitedHealth,” one expert said.

    By Matt Kapko • April 30, 2024
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    Permission granted by CorroHealth
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    Sponsored by CorroHealth

    Empowering healthcare providers against rising payer denials

    The rise in denial rates is more than a mere statistic; it's a symptom of a broader systemic challenge that calls for strategic foresight and robust expertise.

    April 29, 2024
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    Wirestock via Getty Images
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    Kaiser exposed up to 13.4M plan member records to third parties

    The largest data breach reported so far this year comes as regulators reconsider healthcare’s use of tracking technologies.

    By April 26, 2024
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss/Healthcare Dive
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    Centene looks beyond Medicaid redeterminations

    The nation's largest Medicaid insurer expects to return to normal operations this year, though redeterminations continue to dog Centene through a mismatch between rates and acuity. 

    By April 26, 2024
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    rabbit75_ist/iStock/Getty Images Plus via Getty Images
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    Molina to challenge Medicaid contract losses in Florida, Virginia

    Despite business growth in the first quarter, Molina reiterated its prior 2024 guidance out of caution that it won’t be able to reprocure the contested contracts.

    By April 25, 2024
  • protestors hold up signs advocating for universal healthcare
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    Joe Raedle/Getty Images via Getty Images
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    Deep Dive

    California, Oregon eye universal health coverage

    The states' proposals, which resemble Medicare for All, need approval from the federal government and face pushback from major health systems and insurers.

    By John Canham-Clyne • April 24, 2024
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    hapabapa via Getty Images
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    Humana withdraws 2025 earnings outlook on unsatisfactory MA rates

    Because of the final rates for next year, Humana will have to enact “larger benefit reductions to achieve stable margins,” its CFO told investors.

    By April 24, 2024
  • Text of the word 'Medicaid' in the middle of a U.S. dollar bill
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    zimmytws via Getty Images
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    Medicaid final rules hand hospitals win on supplemental payments

    In two final rules issued Monday, the CMS also moved to crack down on financing gimmicks used by states and hospitals to increase federal Medicaid funding — though not until 2028.

    By April 23, 2024
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Permission granted by Elevance Health
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    Elevance notches $2.3B in profit, unfazed by Change attack

    The insurer says it has caught up on claims delayed due to the cyberattack on the clearinghouse earlier this year, and shared more details on a new primary care venture with a private equity firm.

    By April 18, 2024
  • Medicare enrollment form and money.
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    iStock via Getty Images
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    ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says

    Independent practices have clearer financial incentives to lower medical spending than hospitals participating in accountable care organizations, according to the Congressional Budget Office.

    By April 17, 2024
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Permission granted by Elevance Health
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    Elevance partners with private equity firm on primary care

    The payer has inked a deal with Clayton, Dubilier and Rice to join their primary care assets as Elevance looks to catch up with peers like UnitedHealth and CVS in care delivery.

    By April 16, 2024
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    Change Healthcare cyberattack

    UnitedHealth expects up to $1.6B hit from Change cyberattack this year

    Investors on Tuesday got a clearer picture of the cyberattack's financial fallout on the healthcare juggernaut. Some said it wasn't as bad as they'd feared.

    By April 16, 2024