Payer


  • Medicare enrollment form and money.
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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
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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
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    Trendline

    Social determinants of health

    The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.

    By Healthcare Dive staff
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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
  • a medicaid insurance card on top of a small American flag
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    Florida issues Medicaid managed care awards booting out UnitedHealth, CVS and Molina

    Meanwhile, Centene, Elevance and Humana held onto statewide contracts. The reprocurement was especially positive for Centene, which had been expected to lose market share, analysts said.

    By April 15, 2024
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    zimmytws via Getty Images
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    Medicaid redeterminations

    More than 20M disenrolled amid Medicaid redeterminations

    Nearly a quarter of adults removed from the safety-net program since early last year said they are uninsured, according to KFF.

    By April 12, 2024
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    Confusion about Medicaid skewing coverage estimates, study finds

    The number of people enrolled in Medicaid soared over the pandemic, but many enrollees may not have known their coverage had continued, new research suggests.

    By April 10, 2024
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    Michigan divvies out Medicaid contracts, with Centene, Molina seeing minor losses

    However, the insurers could protest Michigan’s decision, potentially mitigating membership erosion.

    By April 9, 2024
  • 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
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    CMS caps broker payments in Medicare Advantage

    The final rule issued last week prevents insurers from paying brokers additional fees for steering beneficiaries to their plans.

    By April 8, 2024
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    Blue Shield of California and Providence at stalemate over contract negotiations

    It's the latest negotiation to spill out of the boardroom and into the public eye as tensions between providers and payers ramp up.

    By April 3, 2024
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    Alex Wong / Staff via Getty Images
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    CMS finalizes ACA network adequacy rule

    Starting in 2026, plans sold in state-based exchanges will be required to meet time and distance standards for provider access that are already applied to plans sold federally.

    By April 3, 2024
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    Alex Wong / Staff via Getty Images
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    Biden administration finalizes modest cut to 2025 Medicare Advantage rates

    Despite heavy lobbying, insurers failed to see MA rates improve in the final rule, which codified a 0.16% decrease to benchmark funding.

    By April 2, 2024
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    One year, 19M disenrollments: A look at Medicaid redeterminations so far

    Threats of fines, procedural errors and more: Here are the major headlines from the past year of states unwinding Medicaid.

    By April 2, 2024
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    Courtesy of UnitedHealth Group
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    UnitedHealth CFO John Rex to replace Dirk McMahon as president

    McMahon announced earlier this year that he would retire from the healthcare behemoth in April. Rex will step up as president, though there’s no word yet on who will assume McMahon’s chief operating officer role.

    By March 29, 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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    Inside CVS Health’s push to transform customer experience

    The transformation, led by Deloitte Digital, focused on increasing customer feedback to identify pervasive issues and closing the loop on customer inquiries.

    By Kristen Doerer • March 29, 2024
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    Alex Wong / Staff via Getty Images
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    Biden administration finalizes rule cracking down on short-term plans

    Democrat lawmakers and patient advocacy groups cheered the final rule for protecting patients from the skimpy plans, while free-market advocates slammed it as limiting coverage options for consumers.

    By March 29, 2024
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    Alex Wong / Staff via Getty Images
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    CMS streamlines Medicaid, CHIP renewal and enrollment in final rule

    It’s the “most robust and meaningful” regulation streamlining Medicaid eligibility since the Affordable Care Act was implemented a decade ago, one lawyer said.

    By March 28, 2024
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    Medicare’s GLP-1 spending is skyrocketing, even without weight loss coverage: KFF

    Gross Medicare spending on the pricey drugs rose from $57 million in 2018 to $5.7 billion in 2022, according to a new analysis from the health policy group.

    By March 27, 2024
  • An injection pen containing the drug semaglutide lies on a white plate.
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    Medicare to cover Novo’s obesity drug for some patients

    Two weeks after the FDA updated Wegovy’s label, Medicare changed its stance to allow people with a history of heart disease to receive treatment, a shift that could further boost access to the fast-selling medicine. 

    By Ben Fidler • March 22, 2024
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    Hospitals could face revenue hit if insurers play hardball over MA: report

    Insurers could increase claims denials and engage in aggressive contract negotiations with hospitals as profitability in the popular plans declines.

    By March 21, 2024
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    Alex Wong via Getty Images
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    CMS launches model to increase primary care investment in Medicare

    Value-based care and physician interest groups said the model should create a more stable cash flow for providers.

    By March 20, 2024
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    Courtesy of Kroger
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    Elevance to buy Kroger’s specialty pharmacy

    Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.

    By March 19, 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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    Government watchdog warns of Medicaid oversight gaps

    The CMS doesn’t require states to report data on outcomes or care denials, and has made “delayed” progress on plans to analyze the information and make it public, according to the Government Accountability Office.

    By March 18, 2024
  • A pregnant person is checked with a stethoscope in a doctor's office.
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    PeopleImages via Getty Images
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    Continuous Medicaid enrollment linked to less postpartum coverage loss, study finds

    States that have expanded Medicaid for a year after pregnancy might see similar coverage gains, researchers wrote.

    By March 13, 2024
  • Mergers and acquisitions
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    Elevance completes Paragon Health acquisition

    The infusion services and drug therapy company will operate under CarelonRx, Elevance’s pharmacy benefit manager.

    By March 11, 2024
  • Cigna's logo is seen on a door.
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    Deep Dive

    Why Cigna is capping cost increases for pricey GLP-1 weight loss drugs

    The move — the first of its kind — comes as pharmacy benefit managers continue to try to prove their value to clients, and shows how major players are shoring up to meet sky-high GLP-1 demand.

    By March 8, 2024