Payer


  • A brick wall with a red CVS Pharmacy sign.
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    Justin Sullivan via Getty Images

    CVS to close Signify acquisition this week

    CVS expects its $8 billion buy of home healthcare provider Signify to close on or near Wednesday, subject to certain conditions.

    By March 27, 2023
  • Senate Health, Education, Labor, and Pensions Committee Chairman Bernie Sanders waving a report as he questions Moderna CEO Stéphane Bancel at a March, 22, 2023 hearing.
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    Chip Somodevilla via Getty Images

    Moderna CEO defends price of COVID shot at Senate hearing

    Stéphane Bancel said his company’s planned price hike covers the higher costs of commercial sales. Sen. Bernie Sanders called it part of industry’s “unprecedented level of corporate greed.”

    By Christopher Newman • March 22, 2023
  • 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
  • The Justice Department building on a foggy morning in Washington, DC.
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    Samuel Corum/Getty Images via Getty Images

    DOJ drops appeal against UnitedHealth’s acquisition of Change

    In a Monday filing with a federal appeals court, the DOJ-led group agreed to withdraw its suit against a ruling that had allowed the merger.

    By March 22, 2023
  • a gavel resting on a blue hospital face mask
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    iStock / Getty Images Plus via Getty Images
    Surprise Billing

    Arbiters instructed to resume No Surprises Act determinations

    The CMS had previously paused and resumed earlier disputes between payers and providers after a Texas judge ruled against the federal government and vacated portions of the law that bans surprise billing.

    By March 21, 2023
  • A person in a white lab coat holds an Ipad and pen and sits across from someone gesturing with their hands.
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    iStock via Getty Images
    Surprise Billing

    Provider directories remain inconsistent, despite No Surprises Act provisions

    In a new study, researchers analyzed health plan provider directories for over 40% of U.S. physicians, and found inconsistencies for 81% of doctors across five major insurers.

    By March 17, 2023
  • doctor on telehealth, telemedicine service analyzing online on EHR, EMR patient digita data on tablet in lab
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    Retrieved from Adobe Stock.
    Opinion

    The health of a community depends on fair health insurance practices

    Access to local and convenient care is critical for a community’s health. However, the current approach from payers puts this at risk, argues Antonio Rios, chief of population health at Northeast Georgia Health System.

    By Antonio Rios • March 17, 2023
  • 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

    CMS lays out plans for negotiating drug prices

    The guidance fills in details for one of the central pharmaceutical provisions of the Inflation Reduction Act, signaling how the agency will use its new authority.

    By Christopher Newman • March 16, 2023
  • An elderly woman sits in a doctor's office as a medical worker writes on a clipboard.
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    Adobe Stock

    Majority of states plan to take their time with Medicaid redeterminations

    Some states are proposing to unwind Medicaid coverage more slowly, while others are moving more quickly to focus on reducing budgetary costs, according to a survey from the Kaiser Family Foundation.

    By March 16, 2023
  • Oscar Health ads
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    Courtesy of Oscar Health

    Oscar Health names current physician leader new CMO

    Sean Martin is stepping up as chief medical officer of the New York-based insurer, after Oscar’s old CMO left to become CMO of L.A. Care Health Plan in December.

    By March 15, 2023
  • A calculator and stethoscope rest on a medical bill.
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    erdikocak via Getty Images

    Physicians say prior authorization rules harm patients, AMA survey finds, as CMS works toward new policy

    Over a third of physicians said the requirements led to a serious adverse event for one of their patients, such as hospitalization, permanent impairment or death, the survey found.

    By March 14, 2023
  • Joe Biden stands at a podium in front of a large blue sign that says "President Joe Biden Investing in America"
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    Chip Somodevilla/Getty Images via Getty Images

    Biden’s proposed HHS budget aims to make pandemic-era subsidies permanent

    The budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.

    By March 9, 2023
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    Getty Images

    House committee latest to launch investigation into PBMs

    It’s the most recent action targeting PBMs for allegedly using their market power to raise drug prices, and comes as the Federal Trade Commission also launched a similar investigation.

    By March 8, 2023
  • 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

    Insurers, trade groups ask CMS to delay MA rule

    Insurance lobbyists argue that the 1.03% plan increase is insufficient and, in combination with other changes, would actually result in payment cuts.

    By March 7, 2023
  • Doctors operate on a patient.
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    South_agency via Getty Images

    FTC pushes back deadline for public to weigh in on noncompete ban

    FTC Commissioner Christine Wilson said she would have supported an even longer extension since the proposed rule is “a departure from hundreds of years of precedent.” 

    By March 7, 2023
  • U.S. President Joe Biden delivers his State of the Union address during a joint meeting of Congress in the House Chamber of the U.S. Capitol on February 07, 2023 in Washington, DC.
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    Win McNamee via Getty Images

    Biden’s plan to improve Medicare solvency targets prescription drugs

    The plan — part of Biden’s 2024 budget proposal set to be released Thursday — would further reduce what Medicare pays for prescription drugs and raise taxes on Americans earning over $400,000.

    By March 7, 2023
  • Dollar bills and finance and banking on digital stock market financial exchange
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    SARINYAPINNGAM via Getty Images

    Bright Health chases cash after overdrawing credit facility

    Bright is facing a new threat to its solvency after overdrawing on credit amid efforts to discontinue its health insurance exchange business.

    By March 1, 2023
  • A stethoscope rests on a medical insurance claim form.
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    iStock / Getty Images Plus via Getty Images

    Gross margins in MA market returned to pre-pandemic levels by end of 2021, report finds

    The analysis of insurer markets in 2021, the latest year of available annual data, sheds light into the varied financial performance of insurers during the COVID-19 pandemic.

    By March 1, 2023
  • An illustration of personal info cards passing through a medical cross shape opening in a person's chest.
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    Illustration: Yann Bastard for Industry Dive 

    Deep Dive

    Hacking healthcare: With 385M patient records exposed, cybersecurity experts sound alarm on breach surge

    Healthcare companies must harden their defenses, but it may require regulators and lawmakers to raise the bar on security standards, experts say.

    By Feb. 28, 2023
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    Fotolia
    Surprise Billing

    CMS says surprise billing arbitration can resume for some disputes — others remain on pause

    Regulators are continuing to work on new guidance in light of a court decision that ruled against the government and threw a wrench in the third-party process to resolve payment disputes between payers and providers.

    By Feb. 27, 2023
  • An illustration of a stethoscope in the shape of a dollar sign.
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    dventtr via Getty Images

    Humana exits employer insurance, pivots focus to government plans

    The insurer said its employer segment no longer meets Humana’s long-term strategic plans.

    By Feb. 24, 2023
  • Healthcare One year into COVID-19 crisis
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    Adeline Kon/Healthcare Dive
    Opinion

    Partisan gridlock shouldn’t threaten true value in healthcare

    Oak Street CEO Mike Pykosz makes the case for value-based healthcare policy despite potential partisan gridlock in the 118th Congress.

    By Mike Pykosz • Feb. 24, 2023
  • A Cigna logo behind a construction fence.
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    Matt Slocum/AP

    Cigna secures restraining order, barring executive from joining CVS

    A judge said Cigna “would suffer irreparable harm absent a temporary injunction” and that it was “inevitable” that the employee, Amy Bricker, would share or use Cigna’s trade secrets while at CVS. 

    By Feb. 22, 2023
  • UnitedHealth Group's headquarters building in Minnetonka, Minnesota.
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    UnitedHealth Group

    UnitedHealth closes $5.4B buy of home health business LHC

    LHC will become part of UnitedHealth’s health services arm Optum to help deliver integrated care, as demand for home and community care increases.

    By Feb. 22, 2023
  • Medicaid enrollees largely unaware of upcoming redeterminations, survey finds

    About 64% of adults in a Medicaid-enrolled family said they didn’t know they could lose coverage once eligibility checks resume on April 1, a survey from the Robert Wood Johnson Foundation found.

    By Feb. 21, 2023
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    Deep Dive

    Could Medicaid redeterminations cause short-term health plan signups to spike?

    Short-term plan operators will likely ramp up their marketing in April to nab new consumers from the Medicaid churn, but health policy experts largely aren't concerned.

    By Feb. 21, 2023