Boston Scientific, MDMA call for more transparency, oversight of Medicare Advantage plans

Privately offered Medicare Advantage plans “do not often provide a clear reason for the denial of coverage, and rarely offer any visibility into the evidence and methodology,” trade group MDMA and Boston Scientific said.

By Nick Paul Taylor • Feb. 15, 2023

CMS plans trio of experiments aimed at lowering drug costs

The pilot programs could allow adjusted payments for drugs cleared under accelerated approval and help states manage the costs of gene therapies.

By Christopher Newman • Feb. 15, 2023

Explore the Trendline➔

Social determinants of health

The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.

By Healthcare Dive staff

Elevance Health closes deal to acquire BioPlus

BioPlus will now operate as a part of the insurer’s pharmacy benefit manager, CarelonRx.

By Sydney Halleman • Feb. 15, 2023

Surgical procedures cost significantly more at hospitals in networks versus independent facilities, study finds

The median price for a shoulder arthroscopy was $4,432 at hospitals within a network, compared to $2,643 at independent hospitals, new research in JAMA Network Open found.

By Hailey Mensik • Feb. 14, 2023

HHS pauses surprise billing arbitration after Texas court decision

The process by which health insurers and medical providers hash out payments for surprise bills is still in flux due to a series of lawsuits threatening the dispute resolution process.

By Rebecca Pifer • Feb. 13, 2023

HHS readies for PHE wind down, end of pandemic flexibilities

A variety of pandemic-era policies will expire May 11, including those allowing providers to prescribe controlled substances via telehealth without an in-person visit and rules requiring payers to cover COVID-19 testing.

By Hailey Mensik • Feb. 10, 2023

Tipping point is in sight: Value-based care is driving meaningful financial results

Strata’s Liz Kirk shares her reflections on value-based care based on the 41st annual J.P. Morgan Healthcare Conference held in San Francisco.

By Liz Kirk • Feb. 10, 2023

Molina expects contract wins to offset Medicaid losses

The forecast comes as its competitor, Centene, expects to lose as many as 2.2 million Medicaid members when pandemic protections end and states resume eligibility checks.

By Samantha Liss • Feb. 9, 2023

Centene reaches $215M settlement with California

This latest settlement is the largest the payer has reached so far regarding state overcharging allegations.

By Samantha Liss • Feb. 9, 2023

Centene set to lose 2M Medicaid members as pandemic protections end

The insurer said it expects to add some members who are no longer eligible for Medicaid to its ACA exchange plans.

By Samantha Liss • Feb. 8, 2023

Cigna restricts coverage of new ALS drug, deepening fears about access

The health insurer’s national formulary considers Amylyx Pharmaceuticals’ Relyvrio to be "experimental, investigational or unproven for any use,” and now does not recommend covering it.

By Jacob Bell • Feb. 8, 2023

Biden zeroes in on drug costs during State of the Union address

The president called for extending Medicare's $35 insulin price cap to all Americans and blasted “big pharma” for record profits while at the same time “unfairly charging people hundreds of dollars.”

By Shannon Muchmore • Feb. 8, 2023

Top healthcare trends of 2023

Providers and payers are still grappling with the fallout from the COVID-19 pandemic, including the winding down of pandemic-era policies, which will have major effects on hospitals and insurers.

By Hailey Mensik • Feb. 8, 2023

CVS, Oak Street stump for $10.6B combination by outlining plans for growth

Linking Oak Street with CVS assets could drive new patients to Oak Street. It could also help Aetna retain more MA members and drive greater use of CVS’ pharmacy and PBM, management said Wednesday.

By Rebecca Pifer • Feb. 8, 2023

CVS buys Oak Street Health for $10.6B

The acquisition is a major development in the strategic positioning of large retailers in the primary care space, analysts said.

By Rebecca Pifer • Feb. 8, 2023

Judge’s ruling on surprise billing threatens to disrupt arbitration process

The ruling tosses out portions of a final rule and raises questions about the arbitration process providers and payers are currently using to resolve payment disputes related to out-of-network care.

By Samantha Liss • Feb. 7, 2023

MA enrollment grew 337% from 2006 through 2022, study finds

Traditional Medicare lost 1 million enrollees over the same period, according to new research published in Health Affairs.

By Hailey Mensik • Feb. 7, 2023

CVS taps new chief diversity, equity and inclusion officer

Shari Slate will lead the company’s strategy concerning its diversity and community initiatives.

By Sydney Halleman • Feb. 6, 2023

Cigna addresses MA overhaul, fresh off $6.7B in profit

CEO David Cordani discussed the CMS’ recent changes to the Medicare Advantage program, Cigna’s multibillion-dollar investment in VillageMD and more in the payer’s fourth-quarter earnings call on Friday.

By Rebecca Pifer • Feb. 3, 2023

More patients — especially younger ones — are switching providers, survey finds

About 30% of patients selected a new provider in 2021, up from 26% in 2017, according to a new report from Accenture. Gen Zers and millennials were six times more likely to switch providers than older people.

By Hailey Mensik • Feb. 2, 2023

CMS issues 2% MA rate hike for 2024

Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

By Shannon Muchmore • Feb. 2, 2023

Texas Medical Association files fourth suit challenging surprise billing ban

The latest lawsuit focuses on boosted fees that both parties must pay for arbitration to solve billing disputes between providers and payers.

By Hailey Mensik • Feb. 1, 2023

Humana expects 14% hike in 2023 MA enrollment as it taps new leaders

The payer said it expects to pick up 625,000 individual Medicare Advantage members in 2023.

By Samantha Liss • Feb. 1, 2023

CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers

Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments. 

By Samantha Liss • Jan. 31, 2023

Insurance lobby blasts Medicare Advantage audit rule

The America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed. 

By Samantha Liss • Jan. 31, 2023