Payer: Page 2

BCBS plans account for nearly half of ACA enrollment, but face rising competition from Medicaid insurers

Medicaid insurers' market share on the exchanges overall ballooned from 15% of the marketplace in 2016 to 27% by 2018.

By Hailey Mensik • June 03, 2020

CMS relaxing more value-based model requirements in wake of pandemic

The changes are aimed at minimizing reporting burden and increasing flexibilities for providers as they continue to face great financial and logistical challenges from the novel coronavirus.

By Shannon Muchmore • June 03, 2020

UPMC latest hospital system to report Q1 loss due to COVID-19

The Pennsylvania-based system's health insurance plan saw increased revenue due to a significant rise in its membership, but its operating income dropped by 56%.

By Ron Shinkman • June 01, 2020

Citing lack of funding, Oklahoma withdraws planned July 1 Medicaid expansion

Millions of Americans have likely been booted off their employer-sponsored insurance and many are newly eligible for Medicaid, something the state didn't anticipate when prepping for the expansion, Republican Gov. Kevin Stitt said.

By Rebecca Pifer • June 01, 2020

Molina, Centene big winners in Kentucky Medicaid award

The lucrative contracts begin next year and cover 1.4 million people with an annual spend of $8 billion.

By Samantha Liss • June 01, 2020

Pathologists most frequent surprise billing offenders, HCCI finds

More than a third of pathologists who billed for inpatient visits did so on an out-of-network basis more than 90% of the time in 2017, according to the Health Care Cost Institute.

By Rebecca Pifer • May 28, 2020

Medicare members using telehealth grew 120 times in early weeks of COVID-19 as regulations eased

CMS head Seema Verma said her department is evaluating the telehealth waivers to determine if they should be extended past the scope of the national emergency, and is in the process of additional rulemaking around the issue.

By Rebecca Pifer • May 27, 2020

COVID-19 has forced nearly half of patients to postpone care

About a third of those who have put off treatment said they would seek it in the next three months, and 10% said they will do so in four months to a year, according to a new survey from the Kaiser Family Foundation.

By Shannon Muchmore • May 27, 2020

Employee wellness programs unlikely to move the needle on health, study finds

Participants said they believed they were healthier and were also more likely to have a primary care physician. However, there was no data showing their health had improved, the new study in JAMA Internal Medicine found.

By Ron Shinkman • May 27, 2020

Over 1,750 Part D, MA plans applied for new CMS insulin model

Payers cheered the effort to lower insulin costs and drugmakers Eli Lilly, Novo Nordisk and Sanofi have said they plan to participate. But powerful lobby PhRMA pushed back against the model.

By Rebecca Pifer • May 26, 2020

MA, Part D final rule gives more star ratings weight to patient experience

The rule also attempts to let more MA plans comply with network adequacy standards by reducing the percentage of rural beneficiaries that must reside within maximum time and distance areas.

By Shannon Muchmore • May 22, 2020

Labs welcome CMS rate for coronavirus antibody testing

Analysts at William Blair said the roughly $42 rate for common serological tests is higher than expected, which may bode well for antigen testing reimbursement.

By Nick Paul Taylor • May 20, 2020

States brace for 'nearly certain' Medicaid budget shortfalls amid COVID-19

The Kaiser Family Foundation survey comes as the House passed a $3 trillion legislative relief package Friday, which would further bump the federal match rate for Medicaid.

By Rebecca Pifer • May 18, 2020

UnitedHealth, Microsoft launch COVID-19 screening app for employers

UnitedHealth will control employees' medical data and manage opt-in and consent requirements for users, the healthcare behemoth said Friday. The app will not provide tracking or contact tracing information.

By Rebecca Pifer • May 15, 2020

ACOs ask Trump admin for more help to cope with coronavirus

Nine organizations, including NAACOs and AMA, want CMS to shelter them from financial losses in exchange for lower shared savings as well as push back some key deadlines.

By Rebecca Pifer • May 15, 2020

Fitch Q2 outlook for nonprofit hospitals: 'worst on record'

Moody's Investors Service also warned this week the impact from the COVID-19 pandemic will linger into next year and noted government assistance won't make up for all the financial losses.

By Hailey Mensik • UPDATED: May 15, 2020 at 9:53 a.m.

Front-line COVID-19 responders in middle of pack on pay

Medscape's annual survey also found men continue to earn more than women, a trend that's held now for a decade. Among primary care physicians, men earn roughly 25% more than women.

By Rebecca Pifer • May 14, 2020

UnitedHealthcare adds new state to ACA exchange footprint

The move comes after the payer's executives last month said they were mulling jumping back in, after largely exiting a few years ago amid steep profit losses.

By Samantha Liss • May 13, 2020

27M Americans may have lost job-based health insurance due to COVID-19 downturn

The new Kaiser Family Foundation estimate also found the coverage gap of those who don't qualify for ACA subsidies or Medicaid could balloon to 1.9 million Americans by 2021 as unemployment insurance runs out.

By Rebecca Pifer • May 13, 2020

Sponsored by ZS

As if the move to value wasn't hard enough, now health plans have new challenges to tackle

As the public health crisis continues to unfold, health systems and independent provider practices are under increasing financial strain while their ability to deliver high-quality care is decreasing. 

By Peter Manoogian • May 13, 2020

Kaiser reports $1.1B net loss in Q1 due to stock market slide

The quarter did include some COVID-19-related costs, including establishing mobile hospitals and triage units and increasing inpatient capacity, but they were "not significant," the integrated system said.

By Rebecca Pifer • May 11, 2020

Hospitals tell court price transparency laws violate 1st Amendment

Thursday's hearing was the first step in what's likely to be a drawn out legal fight. Negotiated rates between hospitals and insurers have long been private, and hospitals want to keep it that way. 

By Hailey Mensik • May 07, 2020

Deep Dive

Despite the pandemic, insurers seem cautiously optimistic about 2020. Here's why.

The nation's largest private payers stuck by their earnings outlooks for the full year, raising questions about why executives are confident about their prospects despite being in the middle of a public health crisis.

By Samantha Liss • May 07, 2020

With new estimate, ICER sets terms of debate on pricing Gilead's COVID-19 drug

The influential watchdog group judged Gilead's remdesivir would be cost effective at $4,500 per treatment course, setting the stage for what's likely to be a controversial decision by the company. 

By Ned Pagliarulo • May 06, 2020

CVS profit rockets up 41%, but warns April COVID-19 hit could persist

The company reported a significant jump in use of digital and at-home offerings in the quarter, including MinuteClinic virtual visits up 600% and retail prescription home delivery up more than 1,000%.

By Rebecca Pifer • May 06, 2020