Payer: Page 2
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MA encounter data lack essential information for fraud protection: OIG report
Medicare Advantage organizations, which cover a third of Medicare beneficiaries, already collect some of the information, but most don't submit it to CMS because it's not a requirement.
By Hailey Mensik • Aug. 26, 2020 -
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Aetna turns to WellBe Senior Medical to deliver at-home care to high-risk seniors
The partnership allows the payer to tightly manage a group of patients that are likely to be more costly — seniors with multiple complex health conditions — by keeping them out of higher-cost settings like a hospital.
By Samantha Liss • Aug. 26, 2020 -
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Some stablished players have paying more attention to patient experience, rolling out improvements such as same-day appointments, apps the help explain coverage or health conditions and better integration with email and text messaging.
By Healthcare Dive staff -
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Louisiana health department wants Medicaid contract search do-over
Centene and Aetna filed protests when they were not awarded the lucrative contracts last year, and an investigation determined the awarding process was "fatally flawed." A new bidding process could end the dispute.
By Hailey Mensik • Aug. 24, 2020 -
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Many COVID-19 cost-sharing waivers set to expire by October: study
The Kaiser Family Foundation report raises concerns more privately insured individuals could soon be exposed to steep medical costs at a time of deep economic and public health instability, even as payers report record profits.
By Rebecca Pifer • Aug. 21, 2020 -
Uber Health forays into prescription drug delivery
The rideshare company is angling for a slice of the lucrative U.S. prescription drug market through a partnership with on-demand prescription delivery platform NimbleRx.
By Rebecca Pifer • Aug. 20, 2020 -
Ryan McKnight / Industry Dive
Lyft claims NEMT program helps Medicaid beneficiary health access
The ridehailing giant and chief rival Uber have touted the efficacy of their non-emergency medical transportation programs, but traditional transportation brokers say they can't meet the niche needs of many U.S. patients.
By Rebecca Pifer • Aug. 19, 2020 -
Threat of financial loss main barrier to value-based model adoption: exec poll
The survey from consultancy Numerof & Associates found the healthcare industry generally supports alternate payment models, but is still falling short of actually tying reimbursement to value.
By Rebecca Pifer • Aug. 19, 2020 -
Cleveland Clinic, Aetna team up on insurance plan, ACO
A nationwide part of the initiative will offer the payer's commercial plan members access to virtual second opinion services from Cleveland Clinic providers. They are also creating a Cardiac Center of Excellence program.
By Shannon Muchmore • Aug. 19, 2020 -
Two-fifths of working-age adults lacked reliable insurance in first half of 2020, Commonwealth Fund says
People of color disproportionately lacked comprehensive coverage and were more likely to struggle financially with medical bills, the report found.
By Rebecca Pifer • Aug. 19, 2020 -
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Employers expect to boost virtual care offerings, survey finds
Business Group on Health's annual survey also found roughly 80% of respondents believe telehealth will play a significant role in how care is delivered in the future, up from 64% in 2019 and 52% in 2018.
By Hailey Mensik • Aug. 18, 2020 -
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Cigna taps former Hilton exec as global CIO
Noelle Eder last held the role of EVP and chief information and digital officer at Hilton Worldwide Holdings. Prior to that, she held leadership roles at Capital One and Intuit.
By Roberto Torres • Aug. 17, 2020 -
Payers win again, court rules Trump admin violated law in axing ACA cost-sharing payments
Judges said, however, that insurers able to raise premiums to offset the loss of the payments in 2018 should not receive the entire unpaid amount.
By Shannon Muchmore • Aug. 14, 2020 -
Oklahoma pulls Medicaid block grant application
The move comes after the state's voters narrowly approved Medicaid expansion last month and is a blow to the Trump administration's attempt to overhaul the program with block grants, long a conservative policy goal.
By Hailey Mensik • Aug. 14, 2020 -
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As Congress eyes an inquiry into insurer profits, experts caution they may not last
"One thing that we can be certain of is that the lower level of claims cost experienced in the second quarter will not continue indefinitely," Bradley Ellis, senior director of North American insurance ratings for Fitch Ratings, said.
By Samantha Liss • Aug. 12, 2020 -
Biden VP pick Harris, early backer of 'Medicare for All,' later pivoted
Among the largest donors to Sen. Kamala Harris' primary run were workers, owners and political action committees associated with healthcare powerhouse Kaiser Permanente.
By Shannon Muchmore • Aug. 12, 2020 -
20 state AGs urge Trump admin to nix proposed tax breaks for health sharing ministries
Saying it would undermine the Affordable Care Act and encourage fraud, the attorneys general called a draft rule arbitrary and particularly dangerous amid the COVID-19 pandemic.
By Ron Shinkman • Aug. 12, 2020 -
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Trump tries to revamp drug supply chain with latest order
A directive announced by the president Thursday would require government agencies to buy certain "essential" drugs from factories in the U.S. How easily such an order would be implemented isn't clear.
By Ben Fidler • Aug. 07, 2020 -
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Payers saw massive Q2 profits as COVID-19 deferred care
Anthem, UnitedHealth and Centene reported at least doubling profits for the quarter. Meanwhile, CVS-owned Aetna and Humana raised their 2020 earnings outlooks.
By Shannon Muchmore • Aug. 07, 2020 -
DOJ sues Cigna, alleging $1.4B in Medicare Advantage fraud
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.
By Hailey Mensik • Aug. 06, 2020 -
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Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up
"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.
By Samantha Liss • Aug. 06, 2020 -
CVS profit soars to $3B on lower medical utilization
The performance of CVS' health benefits arm, which includes major commercial payer Aetna, more than offset a sharp earnings drop in its retail segment as COVID-19 slashed foot traffic to its brick-and-mortar locations.
By Rebecca Pifer • Aug. 05, 2020 -
iRhythm stock leaps 33% after CMS pitches new reimbursement codes
Permanent codes validate the digital health company's wearable heart monitoring technology and could drive more widespread adoption for detection of atrial fibrillation and other abnormal rhythms, CEO Kevin King said.
By Susan Kelly • Aug. 05, 2020 -
Humana
Humana joins peers in reporting depressed usage, larger income in Q2
The payer increased its outlook for earnings and individual Medicare Advantage membership as it saw revenue jump about 17% in the quarter.
By Samantha Liss • Aug. 05, 2020 -
The White House/Healthcare Dive, data from WhiteHouse.gov
CMS expands telehealth coverage in physician fee rule following Trump executive order
The agency is proposing making permanent almost two dozen new telehealth codes. A notable exception is Medicare's temporary reimbursement for audio-only visits, though the agency did ask for public input on the omission.
By Rebecca Pifer • Aug. 04, 2020 -
Oscar expands into 4 new states, touts new virtual primary care option
Flush off raising $225 million in late-stage funding last month and a new initiative with Cigna to sell coverage to small businesses, the startup is looking to grow.
By Ron Shinkman • July 31, 2020
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