Payer: Page 2

CMS launches payment model designed to lower out-of-pocket insulin costs

The new program for Medicare Part D plans would cap insulin copays at $35. Some commercial payers have already made similar moves to lower insulin costs, such as Cigna and Express Scripts.

By Hailey Mensik • March 12, 2020

CVS adds 5 digital health programs for PBM clients

Livongo Health, Hinge Health, Hello Heart, Torchlight and Whil are now available for clients to use, in addition to Sleepio, a personalized digital sleep program and the first participating program when the service launched in 2019.

By Rebecca Pifer • March 12, 2020

UnitedHealth likely to keep squeezing physician staffing firms

Since the insurer's 2018 tussle with ER staffing firm Envision, "it's sort of ramped up and become more aggressive and more abrupt and more pervasive," one analyst said.

By Samantha Liss • March 11, 2020

CMS eases more Medicare restrictions to boost coronavirus treatment access

The actions won't necessarily remove cost barriers for patients. Most payers have not extended the coverage promises to employers' self-insured plans that cover the majority of Americans, and high deductibles persist.

By Shannon Muchmore • March 11, 2020

California accuses healthcare sharing ministry of misleading consumers

States are increasingly cracking down on alternative insurance from healthcare sharing ministries, which aren't required to pay out claims and don't have to cover basic health benefits.

By Rebecca Pifer • March 11, 2020

Hospitals dipping into emergency stocks to combat coronavirus

While more community spread of COVID-19 is reported daily, hospitals are bracing for a rush of patients and payers are waiving fees for telemedicine consults and extra prescription drug supplies.

By Shannon Muchmore • March 10, 2020

LabCorp launches coronavirus test, Quest in the wings

The updates from America's mega-clinical labs come days after FDA OK'd the use of lab developed tests that have not yet received emergency use authorization.

By Maria Rachal • March 05, 2020

Insurer lobby urges coronavirus test coverage, but can't mandate changes

"They can’t require member companies to do anything," Sabrina Corlette, a research professor at Georgetown University, told Healthcare Dive. 

By Samantha Liss • UPDATED: March 6, 2020 at 8:41 a.m.

Humana program to reimburse providers for identifying social determinants like homelessness, food insecurity

The first provider to participate is Ochsner Health, Louisiana's largest non-profit academic healthcare system.

By Hailey Mensik • March 05, 2020

New estimate puts cost to develop a new drug at $1B, adding to long-running debate

Pharma companies spend $300 million to $400 million bringing a new medicine to market, but per-product R&D costs are much higher after accounting for the many drugs that fail in testing. 

By Jonathan Gardner • March 04, 2020

Payer stocks rebound as Super Tuesday results quell M4A fears

A slew of primary wins by former Vice President Joe Biden helped tamp down fears that managed care companies could be downsized or eliminated under "Medicare for All" pushed by Sen. Bernie Sanders.

By Rebecca Pifer • March 04, 2020

JAMA finds public insurance payments increased more than private

Lower back and neck pain and other musculoskeletal disorders accounted for the highest amount of spending in 2016 at an estimated $134.5 billion — 57.2% of which was paid for by private insurance, according to the research.

By Hailey Mensik • March 03, 2020

UnitedHealthcare-Mednax fallout set to hit Raleigh area

Even though North Carolina has some consumer protections when it comes to surprise billing, it will not be enough to shield all patients if and when surprise bills from the pricing squabble arise.

By Samantha Liss • Feb. 27, 2020

Short-term insurance challenger warns plans are a 'threat to public health'

"At the risk of using jargon, this is crazy town bananapants," Association for Community Affiliated Plans​ CEO Margaret Murray said.

By Hailey Mensik • Feb. 27, 2020

Corporate watchdog pegs Centene, CVS CEOs as among most overpaid

With healthcare costs rising faster than inflation, industry executives are ripe targets for criticism over compensation. The payer defended the figure and said it's based on industry standards.

By Rebecca Pifer • Feb. 26, 2020

Tenet closes out 2019 at $243M loss

Volume growth in the fourth quarter was a bright spot for the for-profit hospital operator. Tenet has now reported hospital adjusted admissions gains for four consecutive quarters.

By Rebecca Pifer • Feb. 25, 2020

In a nod toward pharma, ICER makes deal to access real-world evidence

A partnership with Aetion will give ICER more information to include in its drug reviews, but could renew debate on the usefulness of evidence collected outside of clinical study.

By Jonathan Gardner • Feb. 24, 2020

CMS pitches expanding bundled payments for joint replacements

One Wall Street analyst suggested that post-acute care providers, not the manufacturers of pricey medical devices used in surgeries, face the greatest financial risks.

By Ron Shinkman • Feb. 21, 2020

ACOs ask CMMI for more shared savings in direct contracting model

The group asked for more details on the financial methodology to be released immediately, saying members "are finding the lack of information a tremendous hindrance to participation."

By Shannon Muchmore • Feb. 21, 2020

UnitedHealthcare terminates Mednax from its network over pricing squabble

The dispute puts patients, particularly those undergoing surgery, women with high-risk pregnancies and ill newborns, at risk of out-of-network bills in four states: Arkansas, Georgia, North Carolina and South Carolina. 

By Samantha Liss • Feb. 21, 2020

Choice grows in ACA exchanges, report finds, as Supreme Court mulls effort to kill law

A new McKinsey & Company analysis comes as the high court convenes Friday to decide whether to review the Republican lawsuit seeking to overturn the landmark law.

By Rebecca Pifer • Feb. 21, 2020

Deep Dive

Frustrated employers buck status quo, leave insurers for riskier arrangements

"In a nutshell, has it been an easy two to three years? No. But it has to be the way we go because healthcare costs are just going absolutely stupid," the owner of a North Carolina auto group said of the transition.

By Samantha Liss • Feb. 20, 2020

Senseonics' implantable CGM wins Cigna coverage, shares soar

CEO Tim Goodnow late last year identified Cigna, along with Anthem and UnitedHealthcare, as key commercial payers to win over.

By Nick Paul Taylor • Feb. 19, 2020

Price hikes drove employer-sponsored health costs to record high in 2018

The Health Care Cost Institute, drawing on data from Aetna, Humana, Kaiser Permanente and United Healthcare, found higher prices accounted for about three-quarters of the increase, while usage rose just about 3%.

By Hailey Mensik • Feb. 14, 2020

3 surprise billing proposals compared side by side

Congress advanced two proposals last week to ease unexpected medical bills as pressure mounts from consumers. Here are the key elements under consideration.

By Samantha Liss , Shannon Muchmore • Feb. 13, 2020