Payer: Page 2

Molina’s contract wins will have ‘profound impact’ on company, CEO says

The string of Medicaid contracts amount to $5.8 billion in additional annual premium revenue, according to CEO Joe Zubretsky.

By Samantha Liss • Oct. 27, 2022

Express Scripts lands its largest client in Centene

Cigna’s Express Scripts will manage more than $35 billion in annual prescription drug spend for Centene, which will soon be its No. 1 client.

By Samantha Liss • Oct. 26, 2022

Explore the Trendline➔

Payer/Provider relationships

As M&A intensifies and companies are more likely to embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

Nearly half of consumers are in debt due to medical bills, survey finds

Many are struggling to afford their private health insurance and are unprepared for a medical emergency, a poll conducted for telehealth provider Babylon showed.

By Susan Kelly • Oct. 26, 2022

10-week Kaiser strike ends with deal aimed at improving mental health access

About 2,000 mental health clinicians at the system’s facilities in Northern California walked off the job in protest of what they said were prolonged wait times and unmanageable work loads.

By Hailey Mensik • Oct. 25, 2022

Cigna’s Express Scripts wins Centene’s $35B prescription drug contract

The PBM contract is one of the largest to change hands recently, one analyst said. Centene will drop CVS Caremark in 2024.

By Samantha Liss • Oct. 25, 2022

Leveraging AI to benefit the healthcare ecosystem for providers, payers and members

Research revealed leveraging AI will benefit the entire healthcare ecosystem for payers.  

By Bevey Miner, HIT Strategist, Consensus Cloud Solutions • Oct. 24, 2022

Elevance says it’s now the largest US insurer, beating out UnitedHealthcare. Analysts say it’s not that simple.

CEO Gail Boudreaux said the company has solidified its spot as the top insurer, but some analysts aren’t ready to crown the company with that title — yet.

By Samantha Liss • Oct. 21, 2022

Crossover Health in talks with multiple major insurers to offer capitated primary care

Crossover has been working on extending its business model to payer clients for several years now, and will have more news to share by the end of the year.

By Rebecca Pifer • Oct. 21, 2022

Molina whistleblower case moves forward after SCOTUS declines to hear challenge

A former contractor alleged the payer billed and received payment from the Illinois Medicaid program for services it did not provide.

By Hailey Mensik • Oct. 19, 2022

Elevance Health records $1.6B profit as it braces for recession

CEO Gail Boudreaux attempted to temper concerns about the impact a recession may have on the company during a Q3 earnings call Wednesday.

By Samantha Liss • Oct. 19, 2022

Falling MA star ratings dog payers’ future earnings

Volatility in MA stars for the 2023 plan year is raising questions around the earnings outlooks issued by payers.

By Rebecca Pifer • Oct. 18, 2022

DOJ sues Cigna for exaggerating patient illnesses

The insurer paid vendors to conduct in-home visits with its members, then pressured the vendors to record high-value diagnoses that would lead to higher payments for Cigna, the DOJ alleges.

By Samantha Liss • Oct. 18, 2022

HHS approves Medicaid housing intervention program in Arizona

It’s the latest demonstration approval from the agency, following others in Oregon and Massachusetts targeted at expanding access to coverage and addressing nutrition and housing needs.

By Hailey Mensik • Oct. 17, 2022

States need help to enforce mental health parity laws, report finds

Researchers from Georgetown University advocate for more federal support to remove insurance-related obstacles to treatment.

By Susan Kelly • Oct. 17, 2022

Healthcare payments: Remedy these 3 compliance risks

Explore potential consequences and remedies for 3 compliance risks in the healthcare payments space.

Oct. 17, 2022

Price transparency data provides new visibility into real rates paid to providers

Payers can use the data to gain insights regarding the rates hospitals have negotiated with other payers, which potentially can be used during contract negotiations, BRG analysts argue.

By JoAnna Younts and Konstantin Gorelik • Oct. 14, 2022

UnitedHealth raises 2022 earnings outlook following Q3 beat

Management said they expect Change Healthcare to be accretive to earnings starting in 2023, not in 2022 as previously expected.

By Rebecca Pifer • Oct. 14, 2022

Family glitch fix for ACA premium subsidies finalized

The new rule extends premium subsidies to previously ineligible dependents of workers with employer-sponsored coverage.

By Susan Kelly • Oct. 12, 2022

Wasteful administrative costs tied to high US health spending

A Health Affairs research brief identified at least half of nonclinical health expenditures as excessive.

By Susan Kelly • Oct. 11, 2022

Beleaguered Bright slashes footprint, fully exiting ACA markets and restricting MA to 2 states

Bright Health is doubling down on its decision earlier this year to contract its business, halting the sale of ACA plans to focus on care delivery business NeueHealth as well as MA in higher-performing markets.

By Rebecca Pifer • Oct. 11, 2022

Hospitals are hiding prices from patients, advocacy report says

Patient Rights Advocate concluded that some hospitals owned by Ascension and HCA Healthcare are omitting rates for medical services from files made public under new federal rules.

By Susan Kelly • Oct. 10, 2022

Fewer MA plans with Part D earn 4 stars in latest CMS tally

Just over half of plans received four stars or more for 2023, a sharp decrease from 68% last year.

By Susan Kelly • Oct. 10, 2022

Molina closes $110M AgeWell deal

The payer will pick up 13,000 members from New York-based AgeWell who are chronically ill or disabled and covered by its long-term care services.

By Hailey Mensik • Oct. 6, 2022

Providence to refund some 760 low-income patients wrongly charged for care

The refunds come after a New York Times investigation found Providence pressured qualified Medicaid patients to pay for care, even though they were entitled to free services.

By Sydney Halleman • Oct. 6, 2022

Cigna expands MA presence by 22% for 2023

Despite previously lagging in the market, Cigna is now among the fastest-expanding MA providers, analysts said.

By Rebecca Pifer • Oct. 5, 2022