UnitedHealth rolls back gastroenterology prior authorization plan amid backlash

The American Hospital Association said it thinks the new advance notification process is a better approach than prior authorization, but other medical groups took a harsher stance against the refocused policy.

By Rebecca Pifer • June 2, 2023

Over half a million disenrolled amid Medicaid redeterminations so far

A KFF analysis of 11 states found many of the people who have already been removed from the Medicaid program were disenrolled for procedural reasons.

By Emily Olsen • June 1, 2023

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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

Medicare keeps limits on Alzheimer’s drug coverage, but loosens policy

The agency will reimburse Alzheimer’s treatments if they receive full FDA approval, but plans to still require data collection via a patient registry.

By Christopher Newman • June 1, 2023

Healthcare costs top $31,000 for family of 4 in 2023

After declining briefly in 2020, family healthcare costs are rising as the industry faces an uncertain macroeconomic environment.

By Emily Olsen • June 1, 2023

Members’ satisfaction with commercial health plans declines

A J.D. Power study found overall satisfaction with commercial health plans fell, with sicker members less likely to receive outreach and care coordination.

By Emily Olsen • May 31, 2023

Kaiser pledges $10M to safety-net hospital to stem ‘unprecedented financial challenges’

Denver Health — the largest provider of care for uninsured people in the city — has struggled with rising costs and a surge in sicker patients.

By Sydney Halleman • May 31, 2023

Postpartum people could lose coverage amid Medicaid redeterminations

People in some states could lose postpartum coverage 60 days after giving birth, even though health risks from pregnancy can continue for months, according to a new report from KFF.

By Emily Olsen • May 30, 2023

Healthcare provisions of the debt limit deal: COVID-19 funding clawbacks, no Medicaid work requirements

Congressional Republicans and the White House reached a deal over the weekend to raise the debt ceiling that includes healthcare policy wins for both sides of the aisle.

By Rebecca Pifer • May 30, 2023

CVS could lose up to $1B next year from MA star ratings drop

Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed.

By Rebecca Pifer • May 26, 2023

Two-thirds of Medicaid enrollees unaware of redeterminations, survey finds

The KFF survey found many enrollees weren’t sure whether states are now allowed to remove people from the program, and 27% wouldn’t know where to look for coverage if they were ineligible for Medicaid.

By Emily Olsen • May 25, 2023

AHIP chief executive to step down in October

Matt Eyles will depart after serving nearly five years as CEO of AHIP. The organization is launching a nationwide search for his replacement.

By Sydney Halleman • May 25, 2023

US projected to hit record-low uninsurance rate this year

But as federal aid expires, lower-income Americans — who saw the largest insurance gains during the pandemic — will likely be affected the most, according to experts.

By Rebecca Pifer • May 24, 2023

Health tech startup Florence buys Zipnosis from Bright Health

Bright Health, which is exiting the insurance business, purchased telehealth company Zipnosis in 2021.

By Emily Olsen • May 24, 2023

Biden administration aims to increase Medicaid drug transparency

The notice of proposed rulemaking recommends that the CMS and states get a drug price verification survey tool and negotiate for expensive drugs under Medicaid.

By Brian T. Horowitz • May 24, 2023

House lawmakers, PBM lobby spar over committee hearing

At the latest congressional inquiry into pharmacy benefit managers, lawmakers argued the middlemen profit at the expense of patients and taxpayers.

By Rebecca Pifer • May 24, 2023

What 3 key congressional hearings last week mean for the industry

Political will seems to be rising to address drivers of growing medical costs and poor access to care, according to lawmaker comments on the Hill.

By Sydney Halleman , Rebecca Pifer • May 19, 2023

Senate scrutinizes MA payment denials, including use of algorithms

“Insurers are in effect denying Americans necessary care in order to fatten and pad their bottom lines, and that phenomenon is unacceptable,” Sen. Richard Blumenthal, D-Conn., said at a subcommittee hearing.

By Rebecca Pifer • May 18, 2023

On heels of Amgen lawsuit, FTC broadens investigation of PBMs

The regulator is probing the business practices of two more drug purchasing organizations, deepening an investigation that began last year.

By Kristin Jensen • May 18, 2023

House committee centers blame on PBMs for rising healthcare costs

Conversation about pharmacy benefit management consolidation dominated the hearing, with lawmakers pointing to the middlemen as drivers of high health costs.

By Sydney Halleman • May 18, 2023

Uninsured rate fell 18% during pandemic, CDC finds

The findings reflect government subsidies aimed at boosting healthcare access during the pandemic, and requirements that states keep Medicaid beneficiaries on their rolls during the public health emergency.

By Brian T. Horowitz • May 17, 2023

Appellate court pauses ruling blocking ACA preventive care mandate

The temporary administrative stay, which now legally requires health plans to provide preventive care for over 150 million Americans, applies while an appeal of the March case is considered by the court.

By Sydney Halleman • May 16, 2023

Envision Healthcare files for Chapter 11 bankruptcy

The physician staffing firm suffered from declining profits amid hurdles from the COVID-19 pandemic, prolonged legal battles with health insurers over reimbursement, and regulatory crackdowns on surprise billing.

By Sydney Halleman • May 15, 2023

Rethinking the area deprivation index: a call for more effective measures to promote health equity

Srilekha Palle, visiting fellow at the Independent Women’s Forum, argues that a key health equity indicator used by the Biden administration has significant limitations that could exclude many underserved communities.

By Srilekha Palle • May 12, 2023

Bright Health affirms intention to sell California MA plans as it reports Q1 results

By selling its Brand New Day and Central Health MA plans, Bright Health, which would no longer be in the insurance business following the sale, intends to focus on its consumer care products, CFO Cathy Smith said.

By Brian T. Horowitz • May 10, 2023

Oscar Health will exit from California

The insurer plans to exit the state this year after consistently recording medical loss ratios over 100%, executives said on an earnings call.

By Sydney Halleman • May 10, 2023