Payer: Page 2

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    Utilization, intensity drove US health spending to $5.3T in 2024: CMS

    The U.S. spent 7.2% more on healthcare in 2024. Most of the acceleration was because of greater use and intensity of medical goods and services, not growth in healthcare prices, CMS actuaries said.

    By • Jan. 14, 2026
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    UnitedHealthcare to pilot accelerated MA payments to rural hospitals

    The insurer will cut its MA payment timelines in half for select providers in Oklahoma, Idaho, Minnesota and Missouri in an effort to provide relief to rural hospitals.

    By • Jan. 14, 2026
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    Lilly, Novo test direct-to-employer approach that could cut out PBMs and lower costs

    The GLP-1 giants are the first to try out this new model, but more companies may follow. 

    By Kelly Bilodeau • Jan. 14, 2026
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    Joe Raedle via Getty Images
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    ACA signups lag as enrollment deadline nears

    Some 22.8 million people have signed up for Affordable Care Act plans through early January, slower than last year’s pace but more robust than some experts predicted. Still, the CMS data paints an incomplete picture of the market.

    By • Jan. 13, 2026
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    Courtesy of UnitedHealth Group
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    UnitedHealth ‘aggressively’ gaming Medicare Advantage, Senate investigation finds

    Staffers for Sen. Chuck Grassley, R-Iowa, dove into 50,000 pages of documentation from UnitedHealth for the new report, which accuses the company of maintaining a workforce dedicated to upcoding.

    By • Jan. 12, 2026
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    Powerful PBM lobby names new CEO

    David Marin will become president and chief executive of the Pharmaceutical Care Management Association effective Jan. 30.

    By • Jan. 9, 2026
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    House votes to revive enhanced ACA subsidies

    The House voted 230-196 to extend the financial assistance, which lapsed on Dec. 31, for three years. The measure is not expected to pass the Senate.

    By • Jan. 8, 2026
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    UnitedHealthcare raises bar for doctors to get paid for radiology services

    The change runs counter to the company’s broader efforts to pare back red tape for physicians amid widespread discontent with health insurers.

    By • Updated Jan. 9, 2026
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    Kara Arundel/Healthcare Dive
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    Time’s up: Enhanced ACA subsidies expire

    The expanded tax credits are officially dead after lawmakers failed to secure an extension before the end-of-year deadline. There’s still a chance, though a small one, that they could come back in 2026.

    By • Jan. 1, 2026
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    Courtesy of UnitedHealth Group
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    UnitedHealth commits to changes after independent review

    The healthcare behemoth released results of three highly anticipated external reviews that drilled down on a number of areas for improvement.

    By • Dec. 22, 2025
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    Trump administration proposes stronger insurer price transparency requirements

    The proposed rule aims to tamp down on unwieldy price data files and change how some prices are reported.

    By • Dec. 22, 2025
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    Medicare unveils successor to ACO REACH

    The value-based care pilot will be replaced by ACO LEAD, a new model that providers and analysts say seems to address many of the problems posed by its predecessor.

    By • Dec. 19, 2025
  • A tan and black monument sign with bold orange "Optum" lettering and the address "11000 Optum Circle" sits on a grassy lawn with low shrubs in front of a large, modern office building with glass windows and beige panels. Bare trees and a cloudy sky are in the background.
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    Alamy
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    Optum Rx says 100% of network community pharmacies in cost-based contracts

    PBMs are pivoting reimbursement models to protect pharmacies from what they say is an unsustainable status quo.

    By • Dec. 18, 2025
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    House passes Republican health bill without ACA subsidy extension

    The legislation makes no mention of the financial assistance, setting the subsidies up to lapse in just a few weeks.

    By • Dec. 18, 2025
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    Humana taps ex-Amazon executive as incoming insurance head

    George Renaudin, who has been with Humana for almost 30 years, is retiring, the insurer announced Tuesday. Aaron Martin, previously Amazon’s vice president of healthcare, will take his place.

    By • Dec. 17, 2025
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    Deep Dive

    Goliath v. Goliath

    A Medicare Advantage network spat between Optum and Humana in Washington state appears to be benefiting UnitedHealthcare at the expense of its biggest rival. Antitrust experts are alarmed.

    By • Dec. 16, 2025
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    Sponsored by Zelis

    How health plans can boost star ratings with smarter member engagement

    Struggling with Star Ratings? Discover how smarter engagement can turn scores around.

    Dec. 15, 2025
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    Senate rejects competing health bills, setting up ACA subsidy lapse

    The failure of both bills means enhanced subsidies for Affordable Care Act plans will likely expire at the end of the year. Healthcare groups urged lawmakers to extend the subsidies, noting premiums could skyrocket.

    By • Dec. 11, 2025
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    Democrats’ ACA subsidy extension adds $83B to deficit, boosts insured: CBO

    The plan to extend the more generous financial assistance for three years is expected to go up for a vote in the Senate Thursday, alongside a Republican alternative that would replace the subsidies. 

    By • Dec. 11, 2025
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    Ex-Pfizer executive joins Elevance’s board as insurer pursues pharmacy experience

    Amy Schulman is the second veteran of the pharmaceutical industry that Elevance has added to its board this year.

    By • Dec. 11, 2025
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    Rebecca Pifer/Healthcare Dive
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    CVS to launch ‘engagement’ platform in gamble on consumer, industry interest

    CVS is bringing together its disparate businesses onto one platform, and giving its rivals the option to add their products and services as well. The goal is to improve consumers’ health engagement while generating more revenue.

    By • Dec. 10, 2025
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    Joe Raedle via Getty Images
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    Early ACA enrollment holds steady despite subsidy turmoil

    Some 5.8 million people have signed up for 2026 ACA plans so far, up about 7% year over year. Still, enrollment tends to shift over signup periods, so it’s too early to conclude that the Obamacare exchanges won’t shrink next year.

    By • Dec. 10, 2025
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    Rebecca Pifer/Healthcare Dive
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    Crapo, Cassidy propose enhanced ACA subsidy alternative

    The legislation, which is scheduled for a vote Thursday, would send funds directly to health savings accounts paired with bronze or catastrophic plans offered on the Affordable Care Act exchanges.

    By • Dec. 10, 2025
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    1 in 4 ACA enrollees could go uninsured if subsidies lapse: KFF

    Nearly 60% of survey respondents said they wouldn’t be able to afford a $300 annual increase in healthcare costs without significantly disrupting their finances.

    By • Dec. 8, 2025
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    Aetna updates on prior authorization reform

    The CVS-owned payer is working to bundle multiple prior authorizations for certain conditions into one single review.

    By • Dec. 5, 2025