Payer: Page 17
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Aetna executive ousted as CVS’ Medicare Advantage woes drag into second quarter
On Wednesday, CVS slashed its earnings guidance for the third time this year, announced a plan to cut $2 billion in costs and fired the head of its insurance division Aetna, which continues to struggle with high medical utilization.
By Rebecca Pifer • Aug. 7, 2024 -
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Uninsured rate jumps to 8.2% amid Medicaid unwinding: CDC
Growth in the nation’s uninsured rate could become steeper if subsidies in the Affordable Care Act exchanges expire on schedule next year, according to health policy experts.
By Rebecca Pifer • Aug. 7, 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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Premiums for ACA plans to grow 7% next year: KFF
Insurers cited workforce shortages, hospital consolidation and growing demand for pricey GLP-1 drugs as reasons driving the premium increases for 2025.
By Rebecca Pifer • Aug. 7, 2024 -
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Surprise BillingAppeals court hands providers latest win in No Surprises litigation
The 5th Circuit Court’s decision vacates instructions that arbiters should first consider the qualifying payment amount in deciding payments over contested out-of-network bills. Providers argued that unfairly advantaged insurers.
By Rebecca Pifer • Aug. 6, 2024 -
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Cigna CEO promises ‘aggressive’ defense of pharmacy benefit managers
David Cordani’s comments to investors Thursday come as the payer blew past Wall Street’s expectations for the second quarter, helped by significant growth in its health services division — including PBM Express Scripts.
By Rebecca Pifer • Aug. 1, 2024 -
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Disadvantaged areas less likely to have high-quality Medicare Advantage plans, study finds
The research, which found socially vulnerable counties were more likely to have MA plans rated under 3.5 stars, is the latest highlighting the importance of location in healthcare access.
By Rebecca Pifer • July 31, 2024 -
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Humana expects to lose ‘few hundred thousand’ Medicare Advantage members next year
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.
By Rebecca Pifer • July 31, 2024 -
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HealthEquity data breach could affect 4.3M
The health benefits administrator said a vendor’s user accounts were compromised, and information like contact details, Social Security numbers and medical information could have been exposed.
By Emily Olsen • July 30, 2024 -
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Fewer than half of US adults under 50 can readily afford or access healthcare, analysis finds
The share of Americans who were either “cost insecure” or “cost desperate” when it comes to healthcare have both increased since 2022, a Gallup and West Health survey found.
By Ryan Golden • July 30, 2024 -
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Growth in ACA plans keeps Medicaid giant Centene from worst of redeterminations impact
Centene continued to deal with a mismatch between Medicaid rates and patient acuity in the second quarter, but still exceeded Wall Street’s expectations thanks to Affordable Care Act growth.
By Rebecca Pifer • July 26, 2024 -
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Molina’s Medicaid growth offsets worst of redeterminations pressures in Q2
The California-based insurer also outlined how it remains acquisitive, despite recently sharing plans to purchase ConnectiCare.
By Rebecca Pifer • July 25, 2024 -
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Molina to acquire ConnectiCare for $350M
The acquisition, expected to close in the first half of 2025, will bring the health insurer into Connecticut.
By Emily Olsen • July 24, 2024 -
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PBMs battle bipartisan scrutiny as lawmakers eye industry reform
Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.
By Susanna Vogel , Rebecca Pifer • July 24, 2024 -
Courtesy of Humana
Humana’s CenterWell to open 23 primary care clinics at Walmart stores
CenterWell said it will lease space at Walmart Supercenter stores in four states.
By Emily Olsen • July 24, 2024 -
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Healthcare costs could grow up to 8% next year: PwC
The growth is driven by inflationary pressures, prescription drug spending and rising utilization of behavioral healthcare, according to the consultancy.
By Emily Olsen • July 22, 2024 -
Florida awards additional Medicaid contracts to CVS, UnitedHealth, Molina
The three payers were cut out of the state’s first round of contracts divvied out in April.
By Emily Olsen • July 22, 2024 -
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CMS cracks down on ACA brokers to prevent plan switching
Agents and brokers connecting consumers with Affordable Care Act plans now have to jump new hurdles to change their coverage, following mounting complaints about unauthorized plan switching.
By Rebecca Pifer • July 22, 2024 -
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Humana invests in Medicare choice tool Healthpilot
The startup uses AI to recommend Medicare Advantage, Medicare supplement and prescription drug plans based on enrollees’ healthcare preferences and needs.
By Emily Olsen • July 18, 2024 -
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UnitedHealthcare, Neighborhood Health Plan win Rhode Island Medicaid contracts
The state’s managed care organizations handle health benefits for 90% of its Medicaid beneficiaries each year.
By Emily Olsen • July 18, 2024 -
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Judge dismisses Medicaid fraud suit against Centene’s board
A Pennsylvania pension fund had argued Centene board members failed in their oversight responsibilities and ignored red flags about a Medicaid overbilling scheme.
By Emily Olsen • July 17, 2024 -
Permission granted by Elevance Health
Elevance hits $2.3B in profit but trims long-term guidance
Elevance beat Wall Street expectations in second-quarter results posted Wednesday, despite steep Medicaid membership losses that are affecting revenue forecasts.
By Rebecca Pifer • July 17, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth’s cyberattack response costs to surpass $2.3B this year
The healthcare giant’s new estimate is roughly $1 billion higher than previous forecasts as the cyberattack on subsidiary Change Healthcare continues to hamper its profit outlook.
By Rebecca Pifer • July 16, 2024 -
Surprise Billing
CMS’ first No Surprises audit targets Aetna, finds some noncompliance
The findings are a “big deal,” according to one expert, as CVS’ health insurer didn’t follow some “major requirements that are essential to ensuring that the IDR process runs smoothly.”
By Rebecca Pifer • July 12, 2024 -
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Employers say they’ll double down on healthcare benefits despite rising costs
Companies are split on how to pay for the rising expense, but a slight plurality said in a Mercer survey it was unlikely they’d shift costs onto workers.
By Emilie Shumway • July 11, 2024 -
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CMS proposes 2.9% cut to physician pay for 2025
Regulators said Medicare’s budget neutrality requirement is to blame for the reduction, which was quickly decried by provider groups. However, it’s likely Congress will step in to mitigate the drop.
By Rebecca Pifer • July 11, 2024
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