Payer: Page 19
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Deep DiveHumana and CVS are downsizing their Medicare Advantage plans for 2025. Which insurers could benefit?
Hundreds of thousands of seniors could switch plans during next year’s open enrollment, depending on how drastically the MA market giants slash benefits in an attempt to improve profits.
By Rebecca Pifer • Updated June 10, 2024 -
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Scan Health Plan wins Medicare Advantage star ratings lawsuit
The insurer argued the CMS didn’t follow its stated methodology for calculating quality scores, causing its rating to drop and risking millions of dollars in payments.
By Emily Olsen • June 4, 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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Medicare Advantage sales middleman sues HHS over rule capping broker compensation
AmeriLife’s suit joins at least two others from MA sales groups seeking revisions to the rule for threatening their business model. It also comes with a clock, given a looming deadline for marketing contract negotiations.
By Rebecca Pifer • June 3, 2024 -
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Move over, Medicare Advantage — UnitedHealth, Centene flag higher Medicaid utilization concerns
Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.
By Rebecca Pifer • May 30, 2024 -
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Minnesota’s Medicaid program to block for-profit insurers from participation
The ban initially only affects UnitedHealthcare, which is the sole for-profit managed care organization with a Medicaid contract in the state.
By Rebecca Pifer • May 29, 2024 -
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Express Scripts’ new partnership is an olive branch to independent pharmacies
Cigna’s massive pharmacy benefit manager has unveiled a new collaboration with a network of independent pharmacies at a time of rising tension between PBMs and the pharmacies they pay.
By Rebecca Pifer • May 23, 2024 -
Anna Moneymaker via Getty Images
House committee takes aim at healthcare consolidation, eyes site-neutral payments
Equalizing Medicare payment between sites of service to cut down on provider consolidation is a “no brainer,” one witness testified during the hearing.
By Rebecca Pifer • May 23, 2024 -
Courtesy of Tandem Diabetes Care
Medicare adviser sets recommendations for diabetes device evidence
The panel found time in range was an “extremely important” metric, but members were divided on whether quality of life measures should influence coverage.
By Elise Reuter • May 22, 2024 -
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Latest 340B ruling delivers blow to providers
Drugmakers are allowed to impose conditions on which pharmacies they dispense discounted drugs to in the 340B program, according to an appellate court.
By Sydney Halleman • May 22, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth’s Optum Rx unveils new drug pricing model
Major pharmacy benefit managers are rolling out a flurry of ostensibly transparent and cost-effective models to retain clients and placate scrutiny over their role in rising drug costs.
By Rebecca Pifer • May 21, 2024 -
Sarah Silbiger / Stringer via Getty Images
Senate Finance Committee tackles Medicare physician pay reform
On Friday, the committee released a white paper proposing Medicare adjust doctor reimbursement to account for inflation, a key goal for physician lobbies.
By Rebecca Pifer • May 20, 2024 -
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Kansas jilts CVS in new Medicaid contract awards
Kansas kicked CVS to the curb in favor of an Elevance plan, while awarding contracts to incumbents UnitedHealth and Centene. The contracts are worth roughly $4 billion annually.
By Rebecca Pifer • May 15, 2024 -
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Hospitals charged employers and insurers 254% more than Medicare in 2022: study
Hospitals with larger market shares were among the worst offenders, the Rand Corporation found.
By Susanna Vogel • May 14, 2024 -
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Humana CEO Bruce Broussard to depart July 1
At that time, current Chief Operating Officer Jim Rechtin will take the reins of the health insurer, which is struggling with challenges in Medicare Advantage.
By Rebecca Pifer • May 14, 2024 -
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Deep DiveMedicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1
All major payers saw elevated utilization but only an unprepared few struggled with the trend, the Change Healthcare cyberattack caused minimal financial fallout and a new D-SNP rule opens the door to a Medicare growth opportunity.
By Rebecca Pifer • May 13, 2024 -
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CHS sues MultiPlan for allegedly colluding to lower provider reimbursement
It’s the third lawsuit filed against MultiPlan by a health system in under a year.
By Rebecca Pifer • May 10, 2024 -
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CMS proposes mandatory kidney care model with financial risk for hospitals
The model, if finalized, will test whether putting hospitals on the hook for kidney transplant access and quality might improve the nation’s shoddy system of organ procurement and transplantation.
By Rebecca Pifer • May 9, 2024 -
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MA health assessments contribute to inflated coding intensity: study
Some limits on how the assessments are used might be justified to ensure Medicare Advantage plans aren’t overpaid, researchers wrote.
By Emily Olsen • May 8, 2024 -
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Medicare go-broke date extended to 2036, but warning bells continue ringing
The Medicare trustees’ new projection for insolvency is five years later than previous forecasts, but budget hawks warned action is still needed to shore up the insurance program’s finances.
By Rebecca Pifer • May 7, 2024 -
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Cigna writes down VillageMD investment amid shrinking value
Walgreens’ decision to slash VillageMD’s clinical footprint has reverberated to the financial accounts of the primary care chain’s minority owner — Cigna.
By Rebecca Pifer • May 2, 2024 -
Mario Tama via Getty Images
CVS acquires Medicare Advantage broker Hella Health
The acquisition comes amid rising regulatory scrutiny of insurance brokers and notable turbulence in MA.
By Sydney Halleman , Rebecca Pifer • May 1, 2024 -
Mario Tama via Getty Images
CVS slashes 2024 outlook — again — as Medicare seniors drive spending
Runaway inpatient spending in particular caused CVS’ insurance costs to snowball after returning “to patterns we have not seen since the start of the pandemic,” its CFO said.
By Rebecca Pifer • May 1, 2024 -
Ruben Sprich/Reuters
Change Healthcare cyberattackChange Healthcare, compromised by stolen credentials, did not have MFA turned on
Failing to turn on multifactor authentication, a common cybersecurity safeguard, “underscores pure negligence on the part of UnitedHealth,” one expert said.
By Matt Kapko • April 30, 2024 -
Permission granted by CorroHealth
Sponsored by CorroHealthEmpowering healthcare providers against rising payer denials
The rise in denial rates is more than a mere statistic; it's a symptom of a broader systemic challenge that calls for strategic foresight and robust expertise.
April 29, 2024 -
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Kaiser exposed up to 13.4M plan member records to third parties
The largest data breach reported so far this year comes as regulators reconsider healthcare’s use of tracking technologies.
By Susanna Vogel • April 26, 2024
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