Payer: Page 13
-
Getty Images
CMS proposes new guardrails on Medicare Advantage prior authorizations, marketing
The Biden administration is attempting to push through a slew of reforms to the controversial MA program in its final months in power, though it will need the Trump administration’s buy-in to get them across the finish line.
By Rebecca Pifer • Nov. 27, 2024 -
Getty Images
Biden administration proposes Medicare, Medicaid coverage of pricey weight loss drugs
About 7.4 million Americans with obesity could have insurance coverage for drugs like Wegovy if the Trump administration allows the rule to go into effect — at the cost of $40 billion to federal and state governments.
By Rebecca Pifer • Nov. 26, 2024 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
David Berding via Getty Images
CMS ordered to recalculate UnitedHealthcare’s 2025 MA stars
A Texas federal judge has sided with UnitedHealthcare in determining regulators messed up calculating its Medicare Advantage quality scores for next year. The decision could have big implications for similar pending cases.
By Rebecca Pifer • Nov. 25, 2024 -
Permission granted by Sydney Halleman
AI could be ‘transformational’ for payers, experts say
Insurers could save 20% in administrative costs and 10% in medical costs by harnessing the technology, experts said during a panel hosted by Healthcare Dive.
By Susanna Vogel • Updated Nov. 25, 2024 -
Scott Olson via Getty Images
GLP-1 drug coverage for obesity making inroads with large employers: Mercer
In 2024, coverage for obesity drugs increased to 44% among employers with 500 or more workers, compared to 41% last year, the survey found.
By Ginger Christ • Nov. 22, 2024 -
Nastasic via Getty Images
Healthcare costs are going to increase by double digits again, per WTW
While some factors are out of employers’ control, it’s up to companies to balance rising costs with budget expectations, experts said.
By Caroline Colvin • Nov. 21, 2024 -
Getty Images
UnitedHealth, Cigna, CVS sue FTC over insulin litigation process
The three companies are claiming the FTC’s suit is unconstitutional because it was lodged in the agency’s administrative court, instead of a federal one.
By Rebecca Pifer • Nov. 20, 2024 -
Getty Images
CMS allows 5 states to adopt multiyear continuous Medicaid eligibility for children
The future of such policies is unclear under an upcoming Trump administration, which could rescind approvals or prevent states from implementing waivers.
By Emily Olsen • Nov. 20, 2024 -
Mario Tama via Getty Images
Oak Street Health co-founder departs CVS
Mike Pykosz, who joined CVS with its acquisition of the value-based medical chain in 2023, is departing amid a flurry of high-level ousters at the struggling company. However, Pykosz is leaving voluntarily, CVS said.
By Rebecca Pifer • Nov. 20, 2024 -
Joe Raedle via Getty Images
If enhanced ACA subsidies expire, 4M could become uninsured: report
The enhanced premium tax credits will expire at the end of next year without action from lawmakers. Republicans have previously criticized the subsidies’ cost.
By Emily Olsen • Nov. 19, 2024 -
Getty Images
Offering health insurance is becoming less lucrative
In the third quarter, the seven major publicly traded insurers’ medical loss ratios increased an average of 3.3 percentage points year over year — a major jump in medical costs.
By Rebecca Pifer • Nov. 18, 2024 -
Alex Wong via Getty Images
Top CMS official urges Trump administration to treat Medicaid with care
“Do to others what you would want done to yourself,” Medicaid director Daniel Tsai said Thursday when asked about advice for his replacement in Trump’s HHS. Trump is expected to cut Medicaid eligibility and funding.
By Rebecca Pifer • Nov. 14, 2024 -
Spencer Platt via Getty Images
CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings
Regulators’ assessment of customer support centers has spurred recent lawsuits from insurers. But the metric “is going to have a smaller weighting on star ratings moving forward,” the director of Medicare said.
By Rebecca Pifer • Updated Nov. 15, 2024 -
Samantha Liss/Healthcare Dive
Centene President Ken Fasola to retire next year
Fasola is the second-highest paid executive at the insurer, trailing only CEO Sarah London.
By Rebecca Pifer • Nov. 13, 2024 -
Getty Images
Aetna launched a copay-only health plan. What could it mean for benefits teams?
The plan requires only copays for medical services and prescription drugs up to the plan member’s out-of-pocket maximum, with no deductibles or coinsurance costs.
By Ryan Golden • Nov. 13, 2024 -
Getty Images
DOJ sues to block UnitedHealth’s $3.3B buy of home health firm Amedisys
The DOJ’s complaint is intentionally broad to maximize its chances of success, according to one expert. Still, the incoming Trump administration could throw cold water on the challenge.
By Rebecca Pifer • Nov. 12, 2024 -
Julia Rendleman via Getty Images
Cigna confirms it is not pursuing Humana acquisition
The flat-out denial comes after Cigna CEO David Cordani tried to discourage persistent speculation of a Humana merger earlier this fall.
By Rebecca Pifer • Nov. 11, 2024 -
Getty Images
MedPAC backs tying physician pay to inflation, but ducks specifics
During a meeting Thursday, commissioners debated different solutions to lackluster physician pay with one theme in common: linking doctors’ annual payment update to the Medicare Economic Index.
By Rebecca Pifer • Nov. 8, 2024 -
Chip Somodevilla via Getty Images
How the healthcare industry is reacting to a second Trump term
Donald Trump’s first term as president was characterized by significant turbulence for government healthcare programs. Here’s how some of the most influential industry groups responded to the Republican’s reelection.
By Rebecca Pifer • Nov. 7, 2024 -
Mario Tama via Getty Images
CVS appoints new Aetna head following mixed third-quarter results
This year has been defined by an unsuccessful fight against elevated medical costs for CVS. The third quarter was no different.
By Rebecca Pifer • Nov. 6, 2024 -
Scott Olson via Getty Images
Few state Medicaid programs cover GLP-1s for obesity: KFF
Still, gross spending on the drugs increased by more than 500% from 2019 to 2023, according to the health policy research firm.
By Emily Olsen • Nov. 6, 2024 -
Getty Images
MACPAC calls for greater transparency amid steep rise in Medicaid directed payments
Dramatic growth in an opaque Medicaid funding mechanism is exacerbating concerns about the program’s fiscal integrity — while spurring financial gains for the hospital industry.
By Rebecca Pifer • Nov. 5, 2024 -
Getty Images
Surprise BillingFederal government notches rare win in surprise billing lawsuit
Last week, the 5th Circuit Court of Appeals sided with the federal government’s original interpretation of the No Surprises Act in determining how a key metric in billing disputes is calculated.
By Sydney Halleman • Nov. 5, 2024 -
Permission granted by Elevance Health
Elevance Health sues HHS over Medicare Advantage star ratings
The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.
By Emily Olsen • Nov. 4, 2024 -
Adobe Stock/Monkey Business
Sponsored by VeradigmClosing the gaps: Enhancing patient outcomes through effective care gap management
Unlock better patient outcomes by identifying and closing critical gaps in care.
By Joseph Ryan • Nov. 4, 2024
Previous
