Payer

FTC tells states to avoid shielding hospital mergers from antitrust enforcement

A report released Monday compiles research that shows arrangements, called Certificates of Public Advantage, result in higher prices, lower quality of care and lower wage growth for employees.

By Samantha Liss • Aug. 16, 2022

Cigna, Oscar to offer small business plans in Philadelphia

Insurtech Oscar is pushing further into the small employer market through its partnership with Cigna while it holds off on adding more full-service agreements.

By Susan Kelly • Aug. 16, 2022

Explore the Trendline➔

Vertical integration and consolidation

Healthcare companies merging with subsectors of the industry is a growing trend, although certainly not a new one.

By Healthcare Dive staff

Humana inks deal to expand in Medicaid managed care

The payer acquired Wisconsin-based Inclusa on the heels of its $2.8 billion divestiture of Kindred at Home's hospice and personal care units.

By Susan Kelly • Aug. 15, 2022

Cardinal Health CFO will replace CEO Mike Kaufmann

Jason Hollar, who joined Cardinal as CFO in 2020, will lead the healthcare distributor starting in September.

By Samantha Liss • Aug. 15, 2022

House passes bill extending ACA subsidies, allowing Medicare drug price negotiations

The bill, which passed on party lines in a 220-207 vote, will now head to President Joe Biden’s desk. He is expected to sign it into law this week.

By Sydney Halleman • Aug. 15, 2022

Oscar Health pauses full-service tech deals amid implementation woes

The decision to halt new technology agreements doesn’t change Oscar’s financial expectations for 2022, as the insurtech plans to reallocate resources to focus on achieving profitability in its insurance operations next year.

By Rebecca Pifer • Aug. 12, 2022

New York judge dismisses surgeon’s lawsuit challenging surprise billing law

The lawsuit threatened to again expose millions of patients to surprise out-of-network bills.

By Samantha Liss • Aug. 11, 2022

Scan Health Plan makes push into Texas

The Medicare Advantage insurer will cover seniors in a total of four states, pending regulatory approval.

By Samantha Liss • Aug. 10, 2022

Profits climb for major insurers as hospital volumes drop in Q2

All but two of the seven largest insurers saw profits climb in the second quarter as hospital operators continued to struggle with weak volumes and higher labor costs amid record-high inflation.

By Samantha Liss • Aug. 9, 2022

Kaiser Permanente posts Q2 net loss of $1.3B

The Oakland, California-based integrated health system attributed the setback in its quarterly results to market investments.

By Susan Kelly • Aug. 9, 2022

Clover Health’s Toy to step up as CEO as insurtech bolsters revenue

In a call with investors, incoming chief executive Andrew Toy said the path to profitability is “a huge focus” for Clover, and pointed to shrinking its medical loss ratio and controlling operating expense growth as key strategies.

By Rebecca Pifer • Aug. 9, 2022

Senate passes bill extending ACA subsidies, adding Medicare price negotiations

The Inflation Reduction Act looked dead just weeks ago until Sen. Joe Manchin, D-W.Va., announced late last month that he had successfully negotiated with Democrats to pass it.

By Sydney Halleman • Aug. 8, 2022

Cigna’s Q2 profit climbs to $1.6B as fewer patients seek care

The payer raised its revenue and operating income targets for the year as a result of the quarterly performance.

By Samantha Liss • Aug. 4, 2022

CVS could look to regional buys as it plans primary care acquisitions

“We can’t be in ... primary care without M&A. We’ve been very clear about that,” CEO Karen Lynch said during an earnings call Wednesday.

By Sydney Halleman • Aug. 3, 2022

Number of uninsured Americans falls to all-time low

Policy experts are worried, however, that progress on coverage expansion will be threatened when a moratorium on Medicaid disenrollment ends.

By Susan Kelly • Aug. 3, 2022

CVS beats Q2 expectations, Aetna revenue rises nearly 11%

The company raised its full-year guidance despite a $77 million decrease in adjusted operating income, primarily due to declines in its retail segment.

By Sydney Halleman • Aug. 3, 2022

CMS calls for public input to improve Medicare Advantage

The agency wants feedback from a variety of voices on how it can strengthen the popular but increasingly controversial program.

By Susan Kelly • Aug. 1, 2022

Medicare Advantage plans make inflated dialysis payments, study says

Research published in Health Affairs found large chains in the consolidated dialysis sector have the market power to negotiate higher MA reimbursement.

By Susan Kelly • Aug. 1, 2022

Molina’s profit rises to $248M on higher Q2 membership

The insurer’s premium revenue increased 18% in the second quarter compared with the prior-year period as the payer saw membership increase 9%.

By Samantha Liss • July 29, 2022

CVS names first chief psychiatric officer

Taft Parsons, who previously worked for Molina Healthcare and Henry Ford Health System, will be tasked with focusing on mental well-being for patients and leading the Aetna Medical Affairs Behavioral Health organization.

By Shannon Muchmore • July 29, 2022

Senate Dems reach draft deal to extend ACA premiums, lower drug costs

The bill, part of a more than $300 billion package, extends enhanced ACA premiums and allows Medicare to negotiate select prescription drug prices starting in 2026.

By Sydney Halleman • July 29, 2022

Molina pivots to permanent remote work, plans to cut real estate footprint by two-thirds

The payer is headquartered in Long Beach, California, and has offices in New York City and assorted properties in other states. It employs 14,000 people.

By Samantha Liss • July 28, 2022

States mixed on how to improve Medicaid unwinding with PHE end date unknown

States have a wide variety of opinions on how difficult resuming annual eligibility reviews after the COVID-19 public health emergency ends might be, according to MACPAC.

By Rebecca Pifer • July 28, 2022

Centene warns star ratings will be ‘disappointing’

The issues stem from Centene’s WellCare acquisition and plans are already underway to turn the star ratings around, CEO Sarah London said.

By Samantha Liss • July 28, 2022

Humana's Q2 profit jumps to $696M on lower medical costs

One reason for the lower inpatient utilization is the shift to outpatient care, which is primarily driven by orthopedic care, Humana CFO Susan Diamond said.

By Samantha Liss • July 27, 2022