Payer: Page
-
Getty Images
UnitedHealthcare, Humana are gaming Medicare Advantage risk adjustment, analysis finds
The research from the Alliance for Community Health Plans adds to existing evidence that major insurers are unfairly profiting from MA’s risk adjustment system, driving billions of dollars in unnecessary costs.
By Rebecca Pifer Parduhn • Sept. 3, 2025 -
Getty Images
Medicare saved record $2.4B from largest accountable care program last year
ACOs are also improving in quality, according to the CMS data. Still, the Medicare Shared Savings Program has struggled with waning provider buy-in.
By Rebecca Pifer Parduhn • Sept. 3, 2025 -
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 -
Joe Raedle via Getty Images
CVS agrees to pay Massachusetts $12M to settle Medicaid overbilling claims
The retail pharmacy giant has also agreed to annually review its practices to ensure the state’s Medicaid program is getting the lowest possible prices for prescription drugs.
By Rebecca Pifer Parduhn • Sept. 2, 2025 -
Julia Rendleman via Getty Images
Cigna’s Evernorth invests $3.5B in ex-Walgreens specialty pharmacy
The investment in Shields Health Solutions gives Evernorth greater reach into specialty pharmacy services for providers, which Cigna’s COO has called an “important addressable market expansion opportunity.”
By Rebecca Pifer Parduhn • Sept. 2, 2025 -
Getty Images
Medicare Advantage plans frequently deny post-acute care for nursing homes, survey finds
The findings build on other research suggesting that MA insurers restrict care more than they should, especially post-acute services.
By Rebecca Pifer Parduhn • Aug. 28, 2025 -
Tom Brenner via Getty Images
Top healthcare legislation to watch so far this year
Federal lawmakers have proposed dozens of bills targeting core healthcare issues, including 340B, Medicaid, AI and site-neutral payments.
By Healthcare Dive staff • Aug. 28, 2025 -
Courtesy of Blue Shield of California
Blue Shield of California names interim CEO to permanent chief executive
Mike Stuart has been the California Blues giant’s interim CEO since March. Now, he’s officially stepping into the role.
By Rebecca Pifer Parduhn • Aug. 27, 2025 -
Getty Images
Surprise BillingNo Surprises dispute resolution is creating billions of dollars in extra costs, could raise premiums: analysis
Providers are turning to the law’s arbitration process in droves to settle out-of-network claims, one factor fueling spending that could cost consumers down the line.
By Rebecca Pifer Parduhn • Aug. 27, 2025 -
Rob Carr via Getty Images
Johns Hopkins, UnitedHealthcare end contract negotiations after failing to reach agreement
The Baltimore-based system and the major insurer called off contract negotiations, keeping some 60,000 patients out of network.
By Rebecca Pifer Parduhn • Updated Sept. 18, 2025 -
Joe Raedle via Getty Images
Judge stays provisions of Trump administration rule overhauling ACA
A Maryland district judge has paused heightened standards for people verifying their eligibility for subsidies and other key elements of a controversial final rule from July.
By Rebecca Pifer Parduhn • Aug. 25, 2025 -
DC Studio, Adobe Stock
Sponsored by West MonroePrior authorization reform: Turning regulatory pressure into a competitive edge
PA reform: four steps that separate health plan leaders from survivors.
By Dan Howell • Aug. 25, 2025 -
Getty Images
Judge approves $2.8B Blues settlement with providers
The final settlement wraps up 12 years of litigation over Blue Cross and Blue Shield plans’ alleged collusion to lower reimbursement to U.S. providers.
By Rebecca Pifer Parduhn • Aug. 22, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth forms new ‘public responsibility’ board committee
The committee will oversee areas where UnitedHealth has struggled or faced public scrutiny: underwriting and forecasting, regulatory relationships, reputational matters, and M&A.
By Rebecca Pifer Parduhn • Aug. 21, 2025 -
Mario Tama via Getty Images
CVS Caremark fined $290M for Medicare fraud
CVS tried and failed to convince the judge to decrease the penalty. The company plans to appeal the ruling.
By Rebecca Pifer Parduhn • Aug. 20, 2025 -
Getty Images
Medicare Advantage headwinds dinging member satisfaction: survey
Overall customer satisfaction with MA plans fell 29 points year over year, driven by declining member trust, according to J.D. Power.
By Emily Olsen • Aug. 20, 2025 -
Alamy
Elevance loses Medicare Advantage star ratings suit
The Texas judge’s decision — which picked apart Elevance’s argument on mathematical grounds — is expected to cost Elevance $375 million, though the insurer could still appeal.
By Rebecca Pifer Parduhn • Aug. 20, 2025 -
Getty Images
Judge overturns rule limiting broker payments in Medicare Advantage
Reed O’Connor’s ruling is a setback for smaller MA plans — and efforts to curb predatory marketing to seniors.
By Rebecca Pifer Parduhn • Aug. 20, 2025 -
Getty Images
Large employers forecast ‘daunting’ 9% hike in healthcare costs next year
Employers surveyed by the Business Group on Health are bracing for the largest annual increase in healthcare costs in more than a decade — a sobering prospect, one expert said.
By Rebecca Pifer Parduhn • Aug. 19, 2025 -
Getty/Baona
Sponsored by ZelisWhy this summer is make-or-break for star ratings
More star ratings changes are coming – and your actions this summer are critical for Stars success.
Aug. 18, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth closes $3.3B Amedisys buy after long regulatory battle
The settlement between UnitedHealth, Amedisys and the DOJ cleared the way for the deal to be finalized after a long regulatory delay. Amedisys stopped trading on Nasdaq.
By Rebecca Pifer Parduhn • Aug. 15, 2025 -
Anna Moneymaker / Staff via Getty Images
Democrats question Oz on Medicare prior authorization pilot
The CMS plans to trial prior authorization requirements in traditional Medicare. A group of Democrat representatives think that’s a bad idea based on the tool’s track record in Medicare Advantage.
By Rebecca Pifer Parduhn • Aug. 13, 2025 -
Mario Tama / Staff via Getty Images
Hospitals prepare for $149B cut to Medicaid state-directed payments
New limits to the program could force hospitals to slash capital spending while bracing for millions of newly uninsured patients.
By Michael Brady • Aug. 12, 2025 -
Permission granted by Brault Practice Solutions
Sponsored by Brault Practice SolutionsChoose your words wisely: How ICD-10 choices can impact your bottom line
High-complexity workups, triage-level pay? Don’t let automated down-coding undervalue your work.
Aug. 11, 2025 -
Courtesy of UnitedHealth Group
Deep Dive
UnitedHealth, Amedisys merger appears set to close post-DOJ settlement
The settlement is weaker than at least one antitrust expert expected based on the severity of the DOJ’s concerns. But it means the $3.3 billion merger is very likely to close.
By Rebecca Pifer Parduhn • Aug. 8, 2025 -
Andrew Harnik via Getty Images
Democrat senators probe UnitedHealth over nursing home care denials
Sens. Ron Wyden and Elizabeth Warren are seeking more information from the beleaguered healthcare behemoth after The Guardian found it was incentivizing nursing homes to reduce hospital transfers.
By Rebecca Pifer Parduhn • Aug. 8, 2025
Previous
