Payer: Page 2

Payments to MA plans raised overall Medicare spend by $7B in 2019, analysis finds

The Kaiser Family Foundation chalked the higher spending up to how MA is paid, including how benchmarks for plan payments are set and the risk adjustment process.

By Rebecca Pifer • Aug. 18, 2021

Centene's Medicare CFO promoted to segment CEO

Rich Fisher's promotion comes weeks after the insurer reported a $535 million quarterly loss but a 25% growth in its Medicare business.

By Jane Thier • Aug. 17, 2021

Explore the Trendline➔

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

CMS extends deadlines for Medicaid redeterminations after COVID-19 public health emergency ends

Due to significantly increased workloads, state health officials will now have 12 months instead of six after the PHE ends to complete pending verifications, redeterminations and renewals.

By Hailey Mensik • Aug. 17, 2021

Centene awarded Ohio Medicaid contract following $88M settlement

In addition, a subsidiary of Molina has nabbed a Medicaid contract win in Nevada, the payer's first in the state.

By Rebecca Pifer • Aug. 17, 2021

UnitedHealthcare loses Medicare Advantage overpayment suit

An appeals court has reversed a 2018 decision that overturned Medicare's overpayment rule that required insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support.

By Rebecca Pifer • Aug. 16, 2021

AI gains steam, though some execs still not sold at HIMSS21

Data released Wednesday finds 7% of healthcare executives said they believe AI and machine learning are the top priority for the future, while 7% called them a "distraction."

By Rebecca Pifer • Aug. 13, 2021

Deep Dive

Predicting the future of healthcare: 10 takeaways from HIMSS21

Along with "guarded optimism" on the current state of the pandemic, some 19,000 on-site attendees in Las Vegas mulled what's next for AI, telehealth, cybersecurity, mental health and more.

By Rebecca Pifer , Hailey Mensik • Aug. 13, 2021

UnitedHealth settles for $15.6M after Labor Department finds mental health cuts, denials

"You should expect to see more investigation," of those not abiding by the federal mental health parity law, a top DOL official said. "I predict this will be a very active issue for us for years to come."

By Shannon Muchmore • Aug. 12, 2021

Health equity takes center stage at HIMSS21

Significant racial gaps in receiving vaccinations remain, despite the ongoing push to inoculate a greater swath of the U.S. population as the delta variant drives a surge in COVID-19 cases.

By Rebecca Pifer • Aug. 11, 2021

CVS Health's Aetna unveils nationwide primary care telehealth service

The vertically integrated healthcare giant is working with Teladoc to offer the program, which combines telehealth services and access to in-person visits with providers in the CVS Health-Aetna network.

By Susan Kelly • Aug. 11, 2021

Delaware tries capping hospital price growth to fund more primary care

A multi-pronged bill also forces certain payers to tie nearly half of their business to alternative payment models by 2023, and create shared accountability for both the cost and quality of care.

By Samantha Liss • Aug. 09, 2021

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Utilization bounced back for payers in Q2, dinging profitability

Patient volumes returned and drove net income down significantly year over year for insurers, which posted record profits during the same time last year when medical care was largely put off.

By Hailey Mensik • Aug. 06, 2021

Evernorth drives Cigna's Q2 revenue growth despite more return to care than expected

Executives said Thursday that COVID-19-related costs were also higher than anticipated for the quarter.  

By Shannon Muchmore • Aug. 05, 2021

OIG audit targets Aetna's Medicare Advantage plans as government cracks down on fraud

CVS contends the reviews are a regular part of doing business in federal programs, and it "expects CMS and the OIG to continue these types of audits."

By Rebecca Pifer • Aug. 05, 2021

After controversial approval, doctors are still debating how to use Biogen's Alzheimer's drug

Nearly two months since Aduhelm became available, many physicians have yet to use the first treatment approved in the U.S. to slow Alzheimer's disease.

By Jacob Bell • UPDATED: Aug. 3, 2021 at 3:59 p.m.

CVS profit dips to $2.8B as patients return, COVID-19 costs persist

Lagging vaccination rates lead the company to expect the pandemic to be a "modest negative for 2021," CFO Shawn Guertin said. Previously, it expected COVID-19 to have little to no impact on full-year earnings.

By Rebecca Pifer • Aug. 04, 2021

Boston Scientific, Stryker get extra year of add-on payments as CMS adjusts to pandemic

Comments "overwhelmingly supported" the plan to use pre-pandemic data on the cost of inpatient stays to inform CMS' rates for fiscal 2022.

By Nick Paul Taylor • Aug. 03, 2021

CMS axes hospital price transparency mandate from 2022 inpatient payment rule

Hospitals will also receive a 2.5% pay bump for inpatient stays in 2022 under the new rule. That's lower than the 2.8% proposed in the initial draft, but "largely within the range of market expectations," one analyst wrote.

By Rebecca Pifer • Aug. 03, 2021

Molina sees bump in coronavirus inpatient costs as delta variant takes hold

Those COVID-19 costs quickly tapered off as the quarter progressed, executives said. Still, the insurer was able to post a second quarter profit as more members sought care. 

By Samantha Liss • July 29, 2021

How the pandemic has accelerated digital payments in telehealth

Digitalization can simplify the medical bill payment process and give patients more information earlier on about their financial responsibilities, experts said.

By J. Duncan Moore, Jr. • July 28, 2021

Humana warns of 'uncertainty' in medical usage amid rising COVID-19 cases

Medical utilization bounced back faster than the payer expected, though the company was still able to post a profit for the second quarter.

By Samantha Liss • July 28, 2021

'Pent up demand' spurs Centene Q2 net loss as more members seek care

Executives warned, however, that the delta variant is raging. "It remains clear that the pandemic is not over, and the environment could remain choppy for the balance of the year," CEO Michael Neidorff said.

By Samantha Liss • July 27, 2021

Anthem again ups 2021 expectations amid robust membership growth, contract wins

"We have also taken a slightly more cautious view of the back half of the year, in light of new COVID variants, coupled with a slowing vaccination rate," CFO John Gallina said Wednesday.

By Samantha Liss • July 21, 2021

Medical debt overtakes nonmedical as largest source in collections. COVID-19 may be making it worse.

The study published in JAMA also found medical debt was significantly more concentrated in states that didn't expand Medicaid under the Affordable Care Act.

By Rebecca Pifer • July 21, 2021