Payer


  • A gavel and a stethoscope sit on a blue background.
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    DNY59 via Getty Images

    Cigna sues CVS, former pharmacy head Bricker over exec’s departure

    In a lawsuit filed Thursday, Cigna alleged that Amy Bricker’s appointment to chief product officer of CVS’s consumer segment places the payer’s trade secrets at risk and violates her noncompete agreement.

    By Jan. 27, 2023
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    erdikocak via Getty Images

    Employers ‘disappointed’ in health plan performance, study finds

    Health plans earned a lower average rating in the Leapfrog Group’s latest rankings than in previous years.

    By Jan. 26, 2023
  • Explore the Trendline
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    Yujin Kim/Healthcare Dive
    Trendline

    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
  • An illustration of two large hands in opposing directions, one holds a pill while the other holds a stack of cash.
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    Illustration: Yann Bastard for Industry Dive

    Upcoming Medicaid redeterminations could hamper hospitals, payers

    Medicaid eligibility checks beginning in April will likely curb hospital revenue and enrollment growth for payers, Moody's Investors Service said in a report.

    By Jan. 26, 2023
  • picture of a window inside a room where people sit at tables to enroll in healthcare insurance
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    Joe Raedle/Getty Images via Getty Images

    Record-breaking 16.3M people signed up for ACA coverage

    The 2023 enrollment numbers reflect a broader policy push from the Biden administration to increase insurance coverage, especially during the pandemic.

    By Jan. 25, 2023
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Will Elevance’s Louisiana acquisition kick off BCBS consolidation wave?

    The proposed purchase reminds some industry experts of a period beginning in the 1990s, when nonprofit BCBS plans were acquired by for-profit groups.

    By Jan. 25, 2023
  • An illustration of a large dollar coin with medical supplies flying in the foreground is positioned on an analysis tracking chart background.
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Elevance reports $6B profit in 2022 on higher medical membership

    The results come days after the insurer said it plans to buy Blue Cross and Blue Shield of Louisiana, a deal that would expand its reach to 15 states. 

    By Jan. 25, 2023
  • A brick wall with a red CVS Pharmacy sign.
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    Justin Sullivan via Getty Images

    CVS, Rush partner on new ACO for Chicago Medicare patients

    Rush University will be the only Chicago-area academic medical center participating in CVS’ first accountable care organization in ACO REACH.

    By Jan. 24, 2023
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    iStock via Getty Images

    Elevance to acquire Blue Cross and Blue Shield of Louisiana

    The deal will add 2 million members to Elevance’s rolls and push the insurer into its 15th state.

    By Jan. 24, 2023
  • A sign advertises Cigna's free health screenings as the Cigna HIT tour takes to the beach on May 31, 2019 in Virginia Beach, Virginia.
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    Julia Rendleman via Getty Images

    Cigna-owned Express Scripts taps new president

    Previously, Adam Kautzner led pharmaceutical and retail network contracting and drug sourcing as vice president of supply chain for the PBM and Accredo Pharmacy.

    By Jan. 19, 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

    Major government ACOs to cover 13.2M people this year

    Accountable care organizations and value-based care advocates cheered the news, with the National Association of ACOs calling 2023 a “turning point” for growth.

    By Jan. 18, 2023
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    LightFieldStudios via envatoelements

    Uninsured rate fell for those historically lacking coverage

    Researchers in an HHS report said policies like Medicaid continuous coverage and premium tax credits were key to the reduction.

    By Jan. 17, 2023
  • UnitedHealth Group's headquarters building in Minnetonka, Minnesota.
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    UnitedHealth Group

    UnitedHealth, flush off 2022 momentum, eyes membership, value-based growth

    Looking forward, UnitedHealth expects growth of its membership rolls, an increase in fully capitated lives in Optum Health and an acceleration of Optum Insight’s integration with Change Healthcare.

    By Jan. 13, 2023
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    Samara Heisz via Getty Images

    California files suit against PBMs over insulin prices

    The state filed suit Thursday against pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx, alleging they worked with drugmakers to drive up the price of insulin.

    By Jan. 13, 2023
  • Extended subsidies boost ACA marketplace enrollment

    Nearly 16 million people have signed up for health coverage through the Affordable Care Act marketplace since open enrollment began Nov. 1

    By Jan. 11, 2023
  • An illustration of two large hands in opposing directions, one holds a pill while the other holds a stack of cash.
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    Illustration: Yann Bastard for Industry Dive

    Deep Dive

    Key trends for payers and providers in 2023

    Providers are likely to clash with payers over rate hikes after a year of intense cost pressures.

    By Jan. 11, 2023
  • An up-close and above the shoulder picture of Senator Bernie Sanders wearing a medical face mask
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    Chip Somodevilla/Getty Images via Getty Images

    Sen. Bernie Sanders to target high healthcare costs as leader of influential committee

    The longtime Congressman and “Medicare for All” proponent will soon assume leadership of the Senate HELP committee, giving him sway in one of the nation’s most broadly influential health policy forums.

    By Jan. 9, 2023
  • Vials of Eisai and Biogen's new Alzheimer's drug Leqembi
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    Courtesy of Leqembi

    Eisai, in pricing new Alzheimer’s drug, tries to sidestep controversy

    The pharma set the average annual cost of it and Biogen’s newly approved medicine Leqembi to $26,500, below the cost of the companies’ earlier drug Aduhelm but above one estimate of cost effectiveness.

    By Ned Pagliarulo • Jan. 9, 2023
  • A sign for the Food and Drug Administration is seen on July 20, 2020 in Maryland.
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    Sarah Silbiger via Getty Images

    FDA approves Alzheimer’s drug from Eisai, Biogen in closely watched decision

    The agency’s approval comes months after a large clinical trial showed the drug, called Leqembi, could slow the disease’s progression. Yet experts have raised concerns about its safety.

    By Jacob Bell • Jan. 6, 2023
  • California revises Medicaid contract awards, adding 2 insurers

    Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country’s largest Medicaid market.

    By Susan Kelly • Jan. 4, 2023
  • Two emergency room nurses wheel a patient on a gurney through a hospital hallway.
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    Brandon Bell via Getty Images

    The portal to resolve surprise bills has been inundated with disputes — SCP Health tops the list

    Federal agencies received more disputes in a five-month window than they expected to receive in a full year.

    By Updated Jan. 9, 2023
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss for Healthcare Dive

    Centene reaches $44M settlement with Iowa

    It’s the latest deal in a string of settlements to resolve allegations the nation’s largest Medicaid managed care organization overcharged states for pharmacy services.

    By Dec. 21, 2022
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    Stein Photo via Getty Images

    Stakes are high in California’s Medicaid market shakeup

    Four insurers that lost out on lucrative contracts in the state’s first-ever competitive process are challenging the state's picks.

    By Susan Kelly • Dec. 21, 2022
  • An image of a gavel and stethoscope.
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    AndreyPopov via Getty Images

    Judge questions surprise billing ban implementation during court hearing

    A federal judge on Tuesday tested the government’s defense concerning a rule designed to help third parties resolve payment disputes between providers and insurers.

    By Dec. 21, 2022
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    SDI Productions via Getty Images

    CMS rule aimed at improving Medicare Advantage draws praise

    Proposed changes target prior authorization holdups and misleading advertising while aiming to expand access to behavioral health care and affordable prescriptions.

    By Susan Kelly • Dec. 19, 2022
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    Moussa81 via Getty Images

    Texas Medical Association heads to court again in second challenge to surprise billing ban

    The TMA is continuing to argue the surprise billing ban unfairly benefits insurers. It will argue before the same judge who previously sided with the group in a separate but similar case.

    By Dec. 19, 2022