Payer: Page 14
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Medicare saves record $2.1B from largest accountable care program
Citrus ACO in Central West Florida had the highest savings rate, while Health Connect Partners — an ACO operated by hospital giant Providence — had the highest total savings in the Medicare Shared Savings Program last year.
By Rebecca Pifer • Oct. 31, 2024 -
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Cigna CEO tamps down on Humana deal speculation
Despite reports this fall that the two payers had reopened merger talks, Cigna plans to use excess cash to buy back its shares, David Cordani told investors.
By Rebecca Pifer • Oct. 31, 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 -
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Humana boosts 2024 earnings guidance thanks to Medicare Advantage member retention
The insurer said it doesn’t expect earnings growth next year due to significant investments it plans to make to boost MA stars.
By Rebecca Pifer • Oct. 30, 2024 -
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Rising healthcare costs could trickle down to workers: employer survey
Employers said higher drug costs pose the biggest threat to healthcare affordability, according to the National Alliance of Healthcare Purchaser Coalitions report.
By Rebecca Pifer • Oct. 30, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth Group names new CISO 8 months after massive ransomware attack
UnitedHealth Group declined to say if the leadership change came in response to a February ransomware attack that brought the company’s medical claims and processing platform down for more than a month.
By Matt Kapko • Oct. 30, 2024 -
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Centene beats investor expectations despite Medicaid headwinds
Like other payers, Centene flagged a mismatch between patient acuity and payment rates in Medicaid. But the insurer said a diversified portfolio helped it navigate challenges in the third quarter.
By Emily Olsen • Oct. 26, 2024 -
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AMA sues MultiPlan, insurers, alleging ‘cartel’ to fix physician prices
MultiPlan, which denies the allegations, has been sued dozens of times over concerns the company is conspiring with health insurers to underpay doctors for out-of-network care.
By Rebecca Pifer • Oct. 25, 2024 -
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Employees are asking about GLP-1 coverage. What should employers do?
GLP-1 coverage needs to be holistic to ensure long-term success, experts said.
By Caroline Colvin • Oct. 24, 2024 -
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HLTH24‘AI arms race’ underway as payers, providers jockey for upper hand in claims review
Payers currently have a leg up when using AI to review claims, but providers could soon catch up, experts say.
By Susanna Vogel • Oct. 24, 2024 -
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State Medicaid directors concerned about program’s stability: KFF
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
By Rebecca Pifer • Oct. 24, 2024 -
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Molina ‘beating the odds’ in Medicaid
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.
By Rebecca Pifer • Oct. 24, 2024 -
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Insurer lobby blames government policies for 2025 Medicare Advantage market makeup
The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.
By Rebecca Pifer • Oct. 23, 2024 -
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Centene sues HHS over Medicare Advantage star ratings fall
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.
By Rebecca Pifer • Oct. 23, 2024 -
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HLTH24PBM model is a ‘dead man walking.’ What comes next?
Executives from Amazon, Walgreens, Blue Shield of California and PhRMA weighed in on how to fix the much-scrutinized pharmacy benefit manager model during HLTH 2024.
By Susanna Vogel • Oct. 23, 2024 -
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HLTH24Blue Shield of California partners with Salesforce to automate prior authorization
The collaboration comes amid controversy about claims automation technology. Paul Markovich, CEO of Blue Shield of California, promised to keep a "human in the loop" to oversee any denials.
By Susanna Vogel • Oct. 22, 2024 -
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Humana sues HHS over calamitous Medicare Advantage star ratings decrease
It’s the latest in a string of lawsuits from health insurers scrambling to protect their prized quality scores and the money those ratings represent.
By Rebecca Pifer • Oct. 21, 2024 -
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Senate report slams Medicare Advantage insurers for using predictive technology to deny claims
UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.
By Susanna Vogel • Oct. 21, 2024 -
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CVS replaces CEO Karen Lynch with Caremark head
The struggling healthcare giant also pulled its earnings guidance, citing increased medical cost pressures in health benefits.
By Emily Olsen • Oct. 18, 2024 -
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Elevance lowers guidance on ‘unprecedented’ Medicaid challenges
Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.
By Emily Olsen • Oct. 17, 2024 -
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Blue Cross Blue Shield to pay $2.8B to settle class action provider antitrust case
It's the largest antitrust settlement to date in the healthcare industry, according to law firm Whatley Kallas, which represented the plaintiffs.
By Susanna Vogel • Updated Aug. 22, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth lowers adjusted profit outlook as cyberattack costs rise
The insurer has recorded $2.5 billion in total impacts from the attack through the nine months ended Sept. 30, according to UnitedHealth’s third-quarter earnings.
By Emily Olsen • Oct. 15, 2024 -
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Medicare Advantage star ratings fall again in 2025
About 40% of MA plans with prescription drug coverage will earn four or more stars, a dip from 42% this year, according to data released by the CMS.
By Emily Olsen • Oct. 11, 2024 -
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Fewer than 1 in 5 employer-sponsored plans cover GLP-1s for weight loss
While employers footed the bill for health plan price increases in 2024, they were largely unwilling to give employees access to popular weight loss drugs.
By Susanna Vogel • Oct. 10, 2024 -
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UnitedHealth, CVS push to remove FTC Chair Lina Khan from PBM case
Attorneys argue Khan and two other commissioners are biased against pharmacy benefit managers and should recuse themselves from an ongoing lawsuit against the middlemen.
By Emily Olsen • Oct. 10, 2024 -
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Centene completes sale of management services subsidiary
The sale of Collaborative Health Systems to value-based care firm Astrana Health comes after Centene has divested a number of non-core assets in recent years.
By Emily Olsen • Oct. 9, 2024
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