Payer


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    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
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    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
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    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
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    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 May 19, 2022
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    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 May 18, 2022
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    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
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    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 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
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    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 May 11, 2022
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    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 May 9, 2022
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    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 May 6, 2022
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    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
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    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 May 5, 2022
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    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 May 5, 2022
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    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 May 4, 2022
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    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
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    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 May 2, 2022
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    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 May 2, 2022
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    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 April 29, 2022
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    '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 April 29, 2022
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    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 April 28, 2022
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    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 April 27, 2022
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    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 April 27, 2022
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    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