Payer


  • 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 June 2, 2023
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    zimmytws via Getty Images
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    Medicaid redeterminations

    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
  • 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
  • Vials of Eisai and Biogen's new Alzheimer's drug Leqembi
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    Courtesy of Leqembi
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    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
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    9dreamstudio via Getty Images
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    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
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    erdikocak via Getty Images
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    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
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    The image by Jeffrey Beall is licensed under CC BY-SA 3.0
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    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 May 31, 2023
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    Photo by Sarah Chai from Pexels

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    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
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    lucky-photographer via Getty Images
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    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 May 30, 2023
  • A picture of the exterior of a CVS Pharmacy with the logo and name in view.
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    Bruce Bennett via Getty Images
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    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 May 26, 2023
  • a medicaid insurance card on top of a small American flag
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    Kameleon007 via Getty Images
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    Medicaid redeterminations

    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
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    Bill Clark/CQ Roll Call/Newscom

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    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 May 25, 2023
  • A stethoscope rests on a medical insurance claim form.
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    iStock / Getty Images Plus via Getty Images
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    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 May 24, 2023
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    PeopleImages via Getty Images
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    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
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    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
  • Rep. Comer sits in front of a poster outlining the cost differences between a drug dispensed at Cost Plus Drugs versus CVS.
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    Rebecca Pifer/Healthcare Dive
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    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 May 24, 2023
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    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 , May 19, 2023
  • Senator Richard Blumenthal sits in front of a poster illustrating Medicare Advantage coverage denials
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    Rebecca Pifer/Healthcare Dive
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    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 May 18, 2023
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    Carol Highsmith. (2005). "The Apex Building" [Photo]. Retrieved from Wikimedia Commons.
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    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
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    Stefan Zaklin via Getty Images
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    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 May 18, 2023
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    iStock / Getty Images Plus via Getty Images
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    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
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    Stock Photo via Getty Images
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    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 May 16, 2023
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    Chris Hondros/Getty Image via Getty Images
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    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 May 15, 2023
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    erdikocak via Getty Images
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    Opinion

    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
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    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 ads
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    Courtesy of Oscar Health
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    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 May 10, 2023