Payer: Page 2
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Appeals court upholds ACA’s preventive services mandate, but opens door to future challenges
The Fifth Circuit Court of Appeals’ decision Friday is a win for the upwards of 150 million people that receive health insurance through their employers. However, it paves the way for future lawsuits from opponents of the ACA.
By Rebecca Pifer • June 24, 2024 -
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States using unwinding lessons to improve Medicaid: KFF
Medicaid unwinding has been less than perfect. However, the process has helped states expand Medicaid eligibility to more people and streamline enrollment and outreach, according to a new survey.
By Rebecca Pifer • June 21, 2024 -
Explore the Trendline➔
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TrendlineSocial determinants of health
The focus on social determinants of health has only increased because of the impacts of the pandemic, with payers and providers trying to new ways to address the issues.
By Healthcare Dive staff -
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Uninsured rate expected to hit 8.9% over next decade, CBO finds
New government projections chart a rise in the nation’s uninsured rate as policies that swelled healthcare coverage during the coronavirus pandemic expire.
By Rebecca Pifer • June 18, 2024 -
Courtesy of Amazon
Amazon expands drug subscription program to Medicare members
RxPass is now available to more than 50 million Medicare members after Amazon brought it into compliance with the program’s regulatory standards.
By Rebecca Pifer • June 18, 2024 -
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Change Healthcare cyberattackBiden administration gives providers grace period to open surprise billing arbitration
Because of the cyberattack on Change Healthcare earlier this year, providers say they’re having difficultly getting the necessary information from plans required to kick off the dispute resolution process.
By Rebecca Pifer • June 17, 2024 -
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Lawmakers promise to stop kicking the can on Medicare solvency
The House Budget Committee met Thursday and said they’d take action to restore Medicare’s financial footing, though the hearing was light on specifics.
By Rebecca Pifer • June 14, 2024 -
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CMMI’s savings record sparks concern among lawmakers
Republicans at a House subcommittee hearing chided the innovation center for increasing federal spending, even as CMMI’s director said each tested model has resulted in valuable learnings.
By Emily Olsen • June 14, 2024 -
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CMS recalculates Medicare Advantage star ratings in major win for insurers
The redo comes after regulators lost two court cases over the methodology used to determine 2024’s quality ratings and should result in hundreds of millions of dollars in additional bonuses to plans.
By Rebecca Pifer • June 14, 2024 -
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Cardiovascular conditions now the second-highest reimbursement category, Sun Life says
Cost of cardiovascular conditions is up 33% — “higher than we would expect given medical inflation,” the insurance provider said.
By Emilie Shumway • June 13, 2024 -
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National health spending reached $4.8T last year, CMS actuaries estimate
More Americans had insurance in 2023 than at any other time in the nation’s history, spurring medical utilization and accelerating healthcare spending faster than growth in the overall economy, according to government projections.
By Rebecca Pifer • June 12, 2024 -
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MACPAC wants Congress to force states to disclose Medicaid financing streams
The influential advisory group has been lobbying the federal government to collect more detailed information on how states loop providers into funding Medicaid for almost a decade.
By Rebecca Pifer • June 12, 2024 -
Permission granted by Elevance Health
Elevance wins star ratings lawsuit (sort of)
Friday’s district court ruling is the latest suggesting the CMS might have to recalculate every MA plan’s star rating score due to an administrative oversight.
By Rebecca Pifer • June 11, 2024 -
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Sponsored by Veradigm3 ways value-based care is transforming American healthcare
This transition to value-based care is transforming the healthcare system. Medical practices can expect many benefits from this transformation—but only after fully embracing the shift.
By Amanda Cohen, MPH • June 10, 2024 -
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Sponsored by PointClickCareLeveraging technology to achieve balance in healthcare
Leveraging technology is crucial for healthcare to enhance care, automate tasks and optimize outcomes.
By B.J. Boyle, Chief Product Officer, PointClickCare • June 10, 2024 -
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Affordable Care Act insurers could be on the hook for $1.1B in rebates this year
Rebates this year could cross the billion-dollar mark for the fifth time in the past decade, according to an analysis from the KFF.
By Rebecca Pifer • June 7, 2024 -
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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 -
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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 -
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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
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