Payer
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CMS pitches expanding bundled payments for joint replacements
One Wall Street analyst suggested that post-acute care providers, not the manufacturers of pricey medical devices used in surgeries, face the greatest financial risks.
By Ron Shinkman • Feb. 21, 2020 -
ACOs ask CMMI for more shared savings in direct contracting model
The group asked for more details on the financial methodology to be released immediately, saying members "are finding the lack of information a tremendous hindrance to participation."
By Shannon Muchmore • Feb. 21, 2020 -
UnitedHealthcare terminates Mednax from its network over pricing squabble
The dispute puts patients, particularly those undergoing surgery, women with high-risk pregnancies and ill newborns, at risk of out-of-network bills in four states: Arkansas, Georgia, North Carolina and South Carolina.
By Samantha Liss • Feb. 21, 2020 -
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Choice grows in ACA exchanges, report finds, as Supreme Court mulls effort to kill law
A new McKinsey & Company analysis comes as the high court convenes Friday to decide whether to review the Republican lawsuit seeking to overturn the landmark law.
By Rebecca Pifer • Feb. 21, 2020 -
Deep Dive
Frustrated employers buck status quo, leave insurers for riskier arrangements
"In a nutshell, has it been an easy two to three years? No. But it has to be the way we go because healthcare costs are just going absolutely stupid," the owner of a North Carolina auto group said of the transition.
By Samantha Liss • Feb. 20, 2020 -
Senseonics' implantable CGM wins Cigna coverage, shares soar
CEO Tim Goodnow late last year identified Cigna, along with Anthem and UnitedHealthcare, as key commercial payers to win over.
By Nick Paul Taylor • Feb. 19, 2020 -
Price hikes drove employer-sponsored health costs to record high in 2018
The Health Care Cost Institute, drawing on data from Aetna, Humana, Kaiser Permanente and United Healthcare, found higher prices accounted for about three-quarters of the increase, while usage rose just about 3%.
By Hailey Mensik • Feb. 14, 2020 -
3 surprise billing proposals compared side by side
Congress advanced two proposals last week to ease unexpected medical bills as pressure mounts from consumers. Here are the key elements under consideration.
By Samantha Liss , Shannon Muchmore • Feb. 13, 2020 -
CVS swings to $6.6B profit in 2019, buoyed by Aetna
The payer also saw growth in government services, reporting its Medicare Advantage business grew over three times the industry average in 2019, CEO Larry Merlo said Wednesday.
By Rebecca Pifer • Feb. 12, 2020 -
Payers saw medical cost ratios rise in Q4
As the country's major health insurers finished reporting their financial results from the fourth quarter of 2019 this week, a few themes emerged.
By Samantha Liss • Feb. 12, 2020 -
Roger Wollstadt
As SDOH efforts take off, payers try to carve out their role
Signify Community's Jamo Rubin said at a conference this week, "in four years of medical school and then residency, I never learned one thing about what happens to people after they get discharged."
By Rebecca Pifer • Feb. 12, 2020 -
Molina posts mixed Q4, says ACA shoppers not switching for savings
In an effort to drive greater membership in the marketplaces this year, the payer cut prices by 4% on average. But that didn't spur the growth hoped for in 2020, particularly in Texas and Florida.
By Samantha Liss • Feb. 11, 2020 -
Adobe Stock
1 in 5 surgery patients hit with surprise medical bill, JAMA study finds
Anesthesiologist and surgical assistants were associated with the most out-of-network charges. The findings come as lawmakers in Congress debate rival proposals to curb the unexpected bills this week.
By Hailey Mensik • Feb. 11, 2020 -
Kaiser income nearly triples to $7.4B in 2019, driven by investments
The results come as nonprofit healthcare operators across the country face rising scrutiny from regulators and lawmakers for what critics call excessive profits for a tax-exempt entity.
By Samantha Liss • Feb. 10, 2020 -
Q&A
One Medical's CFO on why primary care is ripe for disruption
The company's IPO was for 17.5 million shares at $14, the low end of its range. On the listing day Jan. 31, shares jumped to about $20. Since then, the stock price has continued to rise.
By Shannon Muchmore • Feb. 07, 2020 -
Azar touts 2019 greatest hits, glosses over setbacks in state of HHS speech
He skated over some high-profile efforts from the Trump administration that didn't bear fruit or sparked bad publicity last year, such as efforts to lower drug prices, Medicaid work requirements and cutting away at the ACA.
By Rebecca Pifer • Feb. 07, 2020 -
Fotolia
Rival surprise billing efforts jockey for attention in election year
Two new pieces of draft legislation, one from the House Ways and Means committee and another from the Education and Labor panel, were introduced Friday as Congress struggles to make headway on the issue.
By Rebecca Pifer • UPDATED: Feb. 10, 2020 at 9:55 a.m. -
Getty Images
CMS proposes changes to Part D drug tiers, real-time benefit info for seniors
The proposed rule would also allow patients with end-stage renal disease to enroll in MA plans starting in 2021. Payer groups, however, voiced concerns about the change.
By Samantha Liss • Feb. 06, 2020 -
Cigna touts 2019 medical cost trend
CEO David Cordani defended the company's strategy to pursue partnerships with other players such as Prime Therapeutics and Oscar. "It's a dynamic marketplace and those who create the most value will win," he said.
By Samantha Liss • Feb. 06, 2020 -
Humana
Humana eyes doubling primary care membership, reports MA boost in Q4
Building off a new joint venture between a subsidiary and private equity firm, the payer said its primary care clinics still cover a "relatively small portion" of the overall Medicare Advantage business.
By Shannon Muchmore • Feb. 05, 2020 -
January price increases confirm slowing drug inflation
Payer and public pressure has led to slowing hikes, but more products are subject to increases, analysts say.
By Jonathan Gardner • Feb. 05, 2020 -
Lawmakers push for more oversight at CMS innovation center
A bipartisan group in the House introduced a bill that would require HHS to track how demonstration models impact patient access to care and potentially overhaul or eliminate those found to have adverse effects.
By Hailey Mensik • Feb. 05, 2020 -
Samantha Liss for Healthcare Dive
Flu dampens Centene's Q4 medical loss ratio
CEO Michael Neidorff also weighed in on the Trump administration's proposal to partially reshape the Medicaid program into a block grant system, calling it a potential net positive for payers.
By Samantha Liss • Feb. 04, 2020 -
Humana
Humana expanding primary care centers through joint venture with PE firm
The payer and Welsh, Carson, Anderson & Stowe, which will have majority ownership, are making an initial commitment of about $600 million.
By Shannon Muchmore • Feb. 03, 2020 -
Fotolia
Payers, employers protest price transparency rule as wrong-headed
Most of the 23,355 public comments expressed skepticism or all-out opposition to the Trump administration's proposal targeting insurers.
By Samantha Liss • Jan. 31, 2020
