Payer: Page

  • A tan and black monument sign with bold orange "Optum" lettering and the address "11000 Optum Circle" sits on a grassy lawn with low shrubs in front of a large, modern office building with glass windows and beige panels. Bare trees and a cloudy sky are in the background.
    Image attribution tooltip
    Alamy
    Image attribution tooltip

    UnitedHealth changes leadership at care delivery unit

    Patrick Conway, who recently became chief executive of the larger Optum health services division, will replace Dr. Amar Desai as CEO of Optum Health.

    By Emily Olsen • June 30, 2025
  • The exterior of the Supreme Court of the United States in Washington, D.C.
    Image attribution tooltip
    Chip Somodevilla via Getty Images
    Image attribution tooltip

    Supreme Court upholds ACA preventive services mandate

    The high court preserved a key portion of the Affordable Care Act that requires private insurers to cover a range of preventive healthcare services without cost sharing.

    By Emily Olsen • June 27, 2025
  • Explore the Trendline➔
    Image attribution tooltip
    Yujin Kim/Healthcare Dive
    Image attribution tooltip
    Trendline

    Payer/provider relationships

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

    By Healthcare Dive staff
  • A man exits the front of the U.S. Capitol at dawn.
    Image attribution tooltip
    Win McNamee via Getty Images
    Image attribution tooltip

    Congress should reconsider breaking up pharmacy benefit managers, experts say

    Many popular proposals to reform the PBM industry are missing the forest for the trees, drug market experts said in Washington, D.C. Instead, Congress should go after the root issue: the oligopoly enjoyed by the Big Three PBMs.

    By • June 27, 2025
  • a gavel resting on a blue hospital face mask
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    CVS Caremark to pay $95M in Medicare fraud case

    A federal judge ruled in favor of a whistleblower, finding CVS’ pharmacy benefit manager Caremark overbilled Medicare for generic drugs.

    By • June 26, 2025
  • A medical professional tends to a person on a stretcher.
    Image attribution tooltip
    Mario Tama / Staff via Getty Images
    Image attribution tooltip

    Medicaid, SNAP cuts could lead to nearly 500,000 lost healthcare jobs: report

    A large portion of the 1.2 million jobs that could be lost nationwide in 2029 would come from the healthcare sector, like roles at hospitals, physician offices, pharmacies and long-term care providers.

    By Emily Olsen • June 25, 2025
  • Dr. Mehmet Oz shakes hands with Donald Trump on stage against dark background
    Image attribution tooltip
    Win McNamee via Getty Images
    Image attribution tooltip

    Oz hints at impending CMS rule to force drug price transparency

    The Trump administration hopes to issue a rule by the end of this year empowering regulators to “very forcefully” go after companies that don’t share information on drug costs, the CMS administrator said Tuesday.

    By • June 24, 2025
  • Dr. Mehmet Oz stands behind a podium in front of the American flag.
    Image attribution tooltip
    Rebecca Pifer/Healthcare Dive
    Image attribution tooltip

    Health insurers, nudged by Trump administration, pledge reform to prior authorization

    Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.

    By • June 23, 2025
  • Two men stand on the sidewalk outside of an insurance agency.
    Image attribution tooltip
    Joe Raedle via Getty Images
    Image attribution tooltip

    CMS slashes ACA sign-up periods, tightens eligibility in final rule

    On Friday, the Trump administration finalized a rule that’s expected to cause between 725,000 and 1.8 million people to lose ACA coverage.

    By • June 23, 2025
  • A piece of paper with the word "Medicare" emblazoned on a blue background
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    Medicare go-broke date pushed up three years in latest trustees report

    The clock is ticking to stabilize Medicare, as a key trust fund underpinning the insurance program’s hospital benefit is now set to be depleted in 2033 instead of 2036.

    By • June 20, 2025
  • A stethoscope rests on a medical insurance claim form.
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    ICHRA adoption grows as Congress mulls codifying the coverage into law

    Though the vast majority of individual coverage health reimbursement arrangements remain among small employers, large employers are adopting the plans at a faster clip, the HRA Council found.

    By • June 18, 2025
  • picture of a window inside a room where people sit at tables to enroll in healthcare insurance
    Image attribution tooltip
    Joe Raedle/Getty Images via Getty Images
    Image attribution tooltip

    Federal policies could reverse states’ historic coverage gains: report

    The uninsurance rate for working adults fell from over 20% in 2013 to 11% in 2023. But federal policies like Medicaid cuts threaten that improvement, according to the Commonwealth Fund.

    By Emily Olsen • June 18, 2025
  • Longworth Congressional Building
    Image attribution tooltip
    Win McNamee via Getty Images
    Image attribution tooltip

    GOP Medicaid cuts would cause thousands of preventable deaths: study

    Medicaid provisions in Republicans’ reconciliation megabill would lead to between 8,000 and nearly 25,000 medically preventable deaths, according to new research in the Annals of Internal Medicine.

    By • June 17, 2025
  • Two people are seen inside a Medicare Services office.
    Image attribution tooltip
    Spencer Platt via Getty Images
    Image attribution tooltip

    Humana’s cautious defense of Medicare Advantage

    At the insurer's investor day, Humana struck a middle ground in defending the importance of the privatized Medicare program — which accounts for the bulk of its revenue — while allowing that there’s room for improvement.

    By • June 17, 2025
  • payments fraud Senate scams Mike Crapo
    Image attribution tooltip
    Andrew Harnik via Getty Images
    Image attribution tooltip

    Senate Republicans propose deeper Medicaid cuts in reconciliation bill

    Hospital groups slammed the Senate’s version of the GOP legislation. The upper chamber “made a bad bill worse,” said Chip Kahn, CEO of the Federation of American Hospitals.

    By Emily Olsen • June 17, 2025
  • U.S. Senate Minority Leader Chuck Schumer (D-NY) speaks during a news conference on Senate Republican’s Budget Resolution legislation at the U.S. Capitol on April 03, 2025 in Washington, DC. Schumer was joined by Sen. Richard Blumenthal (D-CT), Sen. Elizabeth Warren (D-MA), Sen. Ron Wyden (D-OR), and Sen. Jeff Merkley (D-OR).
    Image attribution tooltip
    Anna Moneymaker / Staff via Getty Images
    Image attribution tooltip

    Hundreds of rural hospitals at risk if Medicaid cuts pass, Democrats say

    The data released by a group of Democrat lawmakers found 338 rural hospitals were at risk of closure, conversion or service cutbacks if Republicans’ reconciliation bill becomes law.

    By Emily Olsen • June 16, 2025
  • A gavel rests on a pile of money wrapped with a stethoscope.
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    Iowa passes law imposing tighter restrictions on PBMs

    Last week, Gov. Kim Reynolds signed a law seeking to control rising prescription drug costs and protect rural pharmacies by targeting some of the drug middlemens’ most controversial practices.

    By Susanna Vogel • June 16, 2025
  • Employee benefits concept
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    Employers eye rising costs as they assess benefit offerings: WTW

    In light of financial concerns, few employers plan to expand benefit offerings this year, WTW said.

    By Susanna Vogel • June 12, 2025
  • Cigna's logo is seen on a door.
    Image attribution tooltip
    Julia Rendleman via Getty Images
    Image attribution tooltip

    Cigna launches new generative AI assistant for members

    The health insurer is trying to improve the customer experience by connecting them with an AI bot, but analyses show generative AI can make mistakes. 

    By • June 12, 2025
  • Aetna headquarters building with the Aetna logo on its facade.
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    HHS watchdog accuses CVS Medicare Advantage plan of upcoding

    The vast majority of diagnoses codes that CVS subsidiary Coventry submitted to the CMS between 2018 and 2019 weren’t supported by patient documentation, the HHS Office of the Inspector General found.

    By • June 11, 2025
  • One person is standing behind a podium with a sign that reads "One Big Beautiful Bill Act." A handful of other people are standing around and behind the person and they are in a room with wood paneling.
    Image attribution tooltip
    Kevin Dietsch via Getty Images
    Image attribution tooltip

    More than half of adults worry Medicaid cuts could hurt healthcare access: KFF

    Concerns about the policies are split along party lines. Still, more than 30% of Republicans said they were concerned the cuts could negatively impact their ability to get and pay for healthcare.

    By Emily Olsen • June 10, 2025
  • Flag blows outside state capitol building.
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    PBM lobby sues Arkansas over law requiring drug middlemen to sell pharmacies

    The Pharmaceutical Care Management Association is following in the footsteps of two of its largest members — Cigna’s Express Scripts and CVS’ Caremark — that have also sued Arkansas over its controversial law.

    By • June 10, 2025
  • Image of Georgia State Capital building in Atanta, Georgia
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    Public health scholars ask HHS to reject Georgia Medicaid work requirement extension

    The American Public Health Association and dozens of other experts had harsh words for Georgia’s request to continue its controversial “Pathways to Coverage,” saying it enrolls fewer beneficiaries at a higher cost.

    By • June 6, 2025
  • an exterior view of the US Capitol building
    Image attribution tooltip
    Joe Raedle via Getty Images
    Image attribution tooltip

    Nearly 11M would become uninsured under GOP reconciliation bill: CBO

    The latest analysis from the nonpartisan budget scorekeeper found 7.8 million would lose coverage due to Medicaid cuts.

    By Emily Olsen • June 5, 2025
  • Sen. John Thune speaks in front of the West Wing.
    Image attribution tooltip
    Anna Moneymaker via Getty Images
    Image attribution tooltip

    State exchange directors urge Senate to reconsider GOP megabill, citing harm to ACA enrollees

    Seventeen states sent the letter to Senate leadership outlining how Republicans’ reconciliation legislation will kick millions off coverage, sicken risk pools and trample on state autonomy.

    By • June 5, 2025
  • A calculator and stethoscope rest on a medical bill.
    Image attribution tooltip
    Getty Images
    Image attribution tooltip

    Appeals court to rehear No Surprises case in bright spot for providers

    The 5th Circuit could potentially cancel out a rare win it handed the federal government late last year in litigation over the No Surprises Act.

    By • June 4, 2025