Payer

AHA urges DOJ to probe Medicare Advantage plans that deny care

The hospital lobby is pushing the Justice Department to go beyond the recommendations in a new report from the HHS OIG and punish Medicare Advantage organizations that routinely deny coverage to beneficiaries.

By Susan Kelly • May 23, 2022

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

Explore the 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

Google hires former FDA digital health officer to global strategy post

In his new role, Bakul Patel will help Google build a unified digital health and regulatory strategy.

By Samantha Liss • May 19, 2022

Hospitals charge employer health plans more than 2 times what they charge Medicare for same services

Rand researchers also found wide price variations across states. Florida, West Virginia and South Carolina had relative prices at or above 310% of Medicare prices, according to the report.

By Hailey Mensik • May 18, 2022

Oscar faces shareholder lawsuit alleging it misled investors

The insurer is accused of failing to disclose the potential negative impact of the COVID-19 pandemic on its business before its March 2021 IPO.

By Susan Kelly • May 17, 2022

Humana expanding primary care clinics through second joint venture with PE firm

The payer plans to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 through the latest deal.

By Hailey Mensik • May 17, 2022

Insurers seek steep marketplace premium hikes in Vermont

Proposed average increases on individual and family plans would buck the national trend of declining ACA exchange premiums. The increases would reach 17% for MVP Health Care and 12% for Blue Cross Blue Shield.

By Susan Kelly • May 16, 2022

Oscar Health withdraws from 2 states

Leaving Arkansas and Colorado won't have a material effect on the company's income, and should reduce the insurtech's overhead in areas like compliance work and statutory reporting, executives said.

By Rebecca Pifer • May 11, 2022

Insurers saw profits rise in Q1 as cost increases weighed on hospitals

The results spurred payers to paint an improved financial outlook for the full year compared to earlier estimates for 2022.

By Samantha Liss • May 9, 2022

Cigna Q1 profit increased on lower COVID-19 costs as patients were less ill

Cigna executives said medical expenses in the quarter were better than they estimated due to lower COVID-19 testing and treatment costs.

By Samantha Liss • May 6, 2022

Biogen, having scrapped Aduhelm, tries to convince investors of turnaround plan

Though executives claimed that inking deals and de-risking research programs are priorities, analysts questioned whether any meaningful strategic changes will occur in the near term.

By Jacob Bell • May 5, 2022

Centene to sell 2 pharmacy businesses as it advances portfolio review

The news builds on the payer's plan to sell off non-core assets as it looks to sharpen its focus on its main business.

By Samantha Liss • May 5, 2022

Hospital, payer, IT groups urge Congress to overturn ban on unique patient identifier

Industry groups are ratcheting up the pressure on Congress to nix a decadesold ban on using federal funding to create a UPI. Subcommittees, meanwhile, are continuing hearings for 2023 appropriations bills.

By Rebecca Pifer • May 5, 2022

Biogen CEO to step down as company pulls back from Alzheimer's drug

Michel Vounatsos, Biogen's CEO since 2017, will be replaced as the company "substantially" eliminates the commercial workforce around Aduhelm, which has generated paltry sales in the face of resistance from insurers and doctors.

By Jacob Bell • Updated May 3, 2022

Membership growth drives CVS profit up, despite less help from testing, vaccinations

Business trends normalized in the first quarter, with less of a boost from COVID-19 tailwinds for the Rhode Island-based company.

By Rebecca Pifer • May 4, 2022

Insurers may be padding Medicaid physician networks, study finds

Some doctors listed in managed care provider network directories didn't file any Medicaid claims over the course of a year, according to new research published in Health Affairs.

By Susan Kelly • May 3, 2022

ACA-related coverage enrollment tops record at nearly 36M

The expansion of health coverage to more Americans reflects pandemic-related policy efforts, but some of those flexibilities are set to expire this year.

By Susan Kelly • May 2, 2022

Air ambulance provider latest to sue over surprise billing ban

The central issue of the new lawsuit is the guidance the federal government has provided to third-party arbiters.

By Samantha Liss • May 2, 2022

Biden admin suspends Georgia plan to let private sector run ACA marketplace

CMS Administrator Chiquita Brooks-LaSure said the controversial plan would provide coverage to fewer people and no longer complies with federal law and other policies.

By Rebecca Pifer • May 2, 2022

Medicare Advantage plans denied some members needed care, OIG finds

The report calls for improved oversight of MA and urges the CMS to update audit protocols and issue new guidance on medical necessity reviews performed by the plans.

By Samantha Liss • April 29, 2022

'Very false and misleading' criticisms over direct contracting stoked model controversy, stakeholders say

Political ire around direct contracting that came to a head earlier this year was rooted in a "real lack of understanding," one CEO of a physician group said at NAACOS' spring conference.

By Rebecca Pifer • April 29, 2022

Molina's first-quarter COVID-19 costs reached highest peak since pandemic's start, CEO says

Still, those costs were almost entirely offset by members cutting back on healthcare visits, a common trend throughout the pandemic, CEO Joe Zubretsky said Thursday.

By Samantha Liss • April 28, 2022

Centene adds 2 executives to office of the CEO

The now five-person office will assist CEO Sarah London in setting policy and executing the company's enterprise agenda, London announced Tuesday on a call with investors. 

By Samantha Liss • April 27, 2022

Centene addresses 'challenges' in California's Medi-Cal Rx launch

The payer's CEO is addressing concerns around the implementation of the state's new Medicaid prescription drug program, following reports of members struggling to get access and approvals to needed medications.

By Samantha Liss • April 27, 2022

Employers are reevaluating health benefits amid tight labor market, survey finds

Improving affordability, providing virtual care and boosting mental health offerings will be top priorities for U.S. employers over the next two years, according to a Willis Towers Watson report.

By Susan Kelly • April 27, 2022