Payer
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Trump tries to revamp drug supply chain with latest order
A directive announced by the president Thursday would require government agencies to buy certain "essential" drugs from factories in the U.S. How easily such an order would be implemented isn't clear.
By Ben Fidler • Aug. 07, 2020 -
Pixabay
Payers saw massive Q2 profits as COVID-19 deferred care
Anthem, UnitedHealth and Centene reported at least doubling profits for the quarter. Meanwhile, CVS-owned Aetna and Humana raised their 2020 earnings outlooks.
By Shannon Muchmore • Aug. 07, 2020 -
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Some stablished players have paying more attention to patient experience, rolling out improvements such as same-day appointments, apps the help explain coverage or health conditions and better integration with email and text messaging.
By Healthcare Dive staff -
DOJ sues Cigna, alleging $1.4B in Medicare Advantage fraud
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.
By Hailey Mensik • Aug. 06, 2020 -
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Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up
"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.
By Samantha Liss • Aug. 06, 2020 -
CVS profit soars to $3B on lower medical utilization
The performance of CVS' health benefits arm, which includes major commercial payer Aetna, more than offset a sharp earnings drop in its retail segment as COVID-19 slashed foot traffic to its brick-and-mortar locations.
By Rebecca Pifer • Aug. 05, 2020 -
iRhythm stock leaps 33% after CMS pitches new reimbursement codes
Permanent codes validate the digital health company's wearable heart monitoring technology and could drive more widespread adoption for detection of atrial fibrillation and other abnormal rhythms, CEO Kevin King said.
By Susan Kelly • Aug. 05, 2020 -
Humana
Humana joins peers in reporting depressed usage, larger income in Q2
The payer increased its outlook for earnings and individual Medicare Advantage membership as it saw revenue jump about 17% in the quarter.
By Samantha Liss • Aug. 05, 2020 -
The White House/Healthcare Dive, data from WhiteHouse.gov
CMS expands telehealth coverage in physician fee rule following Trump executive order
The agency is proposing making permanent almost two dozen new telehealth codes. A notable exception is Medicare's temporary reimbursement for audio-only visits, though the agency did ask for public input on the omission.
By Rebecca Pifer • Aug. 04, 2020 -
Oscar expands into 4 new states, touts new virtual primary care option
Flush off raising $225 million in late-stage funding last month and a new initiative with Cigna to sell coverage to small businesses, the startup is looking to grow.
By Ron Shinkman • July 31, 2020 -
Molina Q2 profit surges 40% as provider volumes wane
The MCO joined other insurers in posting big profit gains, though it has yet to revise its full-year earnings forecast amid continued COVID-19 uncertainty.
By Samantha Liss • July 31, 2020 -
Fotolia
Medicaid managed care rates on state chopping blocks, with Centene and Molina at risk
Centene execs this week declined to quantify how reductions by states facing shortfalls may impact financial performance or guidance, while Molina provided a direct estimate on Friday.
By Samantha Liss • July 31, 2020 -
Cigna beats in Q2 as commercial enrollment nearly steady despite pandemic
The payer posted profit of $1.75 billion, up nearly 25% year over year. Like other insurers, the company saw increased profit as people deferred care in April and May to forgo potential exposure to the novel coronavirus.
By Shannon Muchmore • July 30, 2020 -
HHS prods Congress to act on surprise billing, but doesn't take a side on how
Congress has taken some action on surprise billing in the face of the coronavirus pandemic, barring the practice for COVID-19 testing and treatment during the public health emergency. Still, a larger overhaul is unlikely soon.
By Shannon Muchmore • July 29, 2020 -
Anthem posts $2.3B profit in Q2 as Medicaid growth outpaces commercial losses
Like for other payers, the COVID-19 pandemic has tamped down healthcare use and resulting costs. Executives said utilization among members was down about 40% in April and 20% in May but returned nearly to baseline last month.
By Shannon Muchmore • July 29, 2020 -
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Telehealth made up almost half of all Medicare beneficiaries' primary care use in April
Fee-for-service beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report.
By Rebecca Pifer • July 29, 2020 -
Permission granted by Heal
Humana invests $100M in at-home primary care startup Heal
"The fact that healthcare belongs in the home — there's an exclamation mark to it, because of the pandemic, but we believed it before," Heal CEO Nick Desai told Healthcare Dive.
By Rebecca Pifer • July 29, 2020 -
Samantha Liss for Healthcare Dive
Centene more than doubles Q2 profit amid pandemic
The results were aided by the COVID-19 crisis as medical use fell due to stay-at-home orders and patients delaying care, though the payer had slower enrollment gains as employers furlough workers instead of terminating them.
By Samantha Liss • July 28, 2020 -
Fotolia
CMS to begin recouping COVID-19 Medicare loans
Hospital groups have pleaded with the Trump administration and Congress to forgive the loans, or relax repayment terms, with no relief so far.
By Rebecca Pifer • July 27, 2020 -
Brian Tucker/Healthcare Dive
6 months in: The COVID-19 crisis
This series of stories examines how healthcare has changed during the course of the novel coronavirus in the United States, half a year after HHS declared a national public health emergency.
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Skinny short-term plans deny coverage for pre-existing conditions: Commonwealth Fund
The analysis of more than 400 plans called junk by critics concluded few offer tangible benefits. The Trump administration backs short-term plans, arguing they're a low-cost alternative to broader coverage.
By Ron Shinkman • July 23, 2020 -
Opinion
Why COVID-19's biggest impact on healthcare may not be until 2022
This perfect storm of a shift in payer mix, the impending insolvency of Medicare and the inability of states to absorb the growing costs of Medicaid represent a tsunami of challenges, former VA Secretary David Shulkin writes.
By David Shulkin • July 23, 2020 -
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M&A volume in health services for H1 was lowest since 2015, PwC finds
The subsector with the most deals in terms of volume was long-term care, continuing a trend since 2014, followed by other services, physician medical groups, hospitals and home health, according to the analysis.
By Shannon Muchmore • July 23, 2020 -
Brian Tucker/Healthcare Dive
Coronavirus vaccine developers make case to Congress they can win public's trust
While developing a safe and effective vaccine remains the chief challenge, lawmakers grilled pharma officials on how any successful shot would be fairly priced and distributed.
By Ben Fidler • July 22, 2020 -
UnitedHealthcare gets lowest grades in Leapfrog poll, average plan gets C+
The biggest commercial payer got the lowest satisfaction ratings on moving toward cost and quality and also the lowest GPA, the new survey of more than 170 employers found.
By Rebecca Pifer • July 22, 2020 -
Direct primary care backers hope COVID-19 entices docs to alternate payment model
Some practices using the model, where patients pay a flat fee with no insurance accepted, say their finances have been relatively unchanged since the start of the pandemic.
By Rebecca Pifer • July 21, 2020
