Payer: Page 20
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Industry condolences, social media vitriol follow UnitedHealthcare CEO’s killing
Brian Thompson’s death set off a flood of darkly celebratory social media posts offset by solemn remembrances from his peers and other healthcare leaders.
By Rebecca Pifer Parduhn • Dec. 5, 2024 -
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About 1 in 3 retail pharmacies have closed since 2010: study
Independent pharmacies were more likely to shut down, possibly because they’re more often excluded from pharmacy benefit managers’ networks, according to research published in Health Affairs.
By Emily Olsen • Dec. 4, 2024 -
Courtesy of UnitedHealth Group
UnitedHealthcare CEO Brian Thompson fatally shot in NYC
The NYPD confirmed the shooting, which cut UnitedHealth’s investor conference short on Wednesday morning. The company said it is “deeply saddened and shocked” by Thompson’s passing.
By Rebecca Pifer Parduhn • Updated Dec. 4, 2024 -
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CMS recalculates Medicare Advantage stars for UnitedHealth, Centene
After both insurers challenged the agency in court, the CMS improved scores for 12 UnitedHealth contracts and seven Centene contracts.
By Rebecca Pifer Parduhn • Dec. 4, 2024 -
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Humana CFO Susan Diamond to step down
Celeste Mellet, currently the finance chief at an infrastructure investment fund, will take on the insurer’s CFO role in early January.
By Emily Olsen • Dec. 3, 2024 -
Joey Sirmons / Healthcare Dive/Healthcare Dive
8 experts on leveraging AI in healthcare
Healthcare organizations must carefully vet AI tools, address patient concerns and keep an eye on standards and regulation, according to industry experts who spoke at a Healthcare Dive virtual event.
By Sydney Halleman • Dec. 3, 2024 -
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Sponsored by VeradigmTransforming payer operations through real-time clinical data exchange
Discover how real-time clinical data exchange enhances payer operations, care quality and efficiency.
Dec. 2, 2024 -
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Nearly a quarter of Americans are underinsured: report
Twenty-three percent of working-age adults with health insurance face high out-of-pocket costs that make it difficult to afford care, according to a survey by the Commonwealth Fund.
By Emily Olsen • Nov. 27, 2024 -
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CMS proposes new guardrails on Medicare Advantage prior authorizations, marketing
The Biden administration is attempting to push through a slew of reforms to the controversial MA program in its final months in power, though it will need the Trump administration’s buy-in to get them across the finish line.
By Rebecca Pifer Parduhn • Nov. 27, 2024 -
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Biden administration proposes Medicare, Medicaid coverage of pricey weight loss drugs
About 7.4 million Americans with obesity could have insurance coverage for drugs like Wegovy if the Trump administration allows the rule to go into effect — at the cost of $40 billion to federal and state governments.
By Rebecca Pifer Parduhn • Nov. 26, 2024 -
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CMS ordered to recalculate UnitedHealthcare’s 2025 MA stars
A Texas federal judge has sided with UnitedHealthcare in determining regulators messed up calculating its Medicare Advantage quality scores for next year. The decision could have big implications for similar pending cases.
By Rebecca Pifer Parduhn • Nov. 25, 2024 -
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AI could be ‘transformational’ for payers, experts say
Insurers could save 20% in administrative costs and 10% in medical costs by harnessing the technology, experts said during a panel hosted by Healthcare Dive.
By Susanna Vogel • Updated Nov. 25, 2024 -
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GLP-1 drug coverage for obesity making inroads with large employers: Mercer
In 2024, coverage for obesity drugs increased to 44% among employers with 500 or more workers, compared to 41% last year, the survey found.
By Ginger Christ • Nov. 22, 2024 -
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Healthcare costs are going to increase by double digits again, per WTW
While some factors are out of employers’ control, it’s up to companies to balance rising costs with budget expectations, experts said.
By Caroline Colvin • Nov. 21, 2024 -
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UnitedHealth, Cigna, CVS sue FTC over insulin litigation process
The three companies are claiming the FTC’s suit is unconstitutional because it was lodged in the agency’s administrative court, instead of a federal one.
By Rebecca Pifer Parduhn • Nov. 20, 2024 -
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CMS allows 5 states to adopt multiyear continuous Medicaid eligibility for children
The future of such policies is unclear under an upcoming Trump administration, which could rescind approvals or prevent states from implementing waivers.
By Emily Olsen • Nov. 20, 2024 -
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Oak Street Health co-founder departs CVS
Mike Pykosz, who joined CVS with its acquisition of the value-based medical chain in 2023, is departing amid a flurry of high-level ousters at the struggling company. However, Pykosz is leaving voluntarily, CVS said.
By Rebecca Pifer Parduhn • Nov. 20, 2024 -
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If enhanced ACA subsidies expire, 4M could become uninsured: report
The enhanced premium tax credits will expire at the end of next year without action from lawmakers. Republicans have previously criticized the subsidies’ cost.
By Emily Olsen • Nov. 19, 2024 -
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Offering health insurance is becoming less lucrative
In the third quarter, the seven major publicly traded insurers’ medical loss ratios increased an average of 3.3 percentage points year over year — a major jump in medical costs.
By Rebecca Pifer Parduhn • Nov. 18, 2024 -
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Top CMS official urges Trump administration to treat Medicaid with care
“Do to others what you would want done to yourself,” Medicaid director Daniel Tsai said Thursday when asked about advice for his replacement in Trump’s HHS. Trump is expected to cut Medicaid eligibility and funding.
By Rebecca Pifer Parduhn • Nov. 14, 2024 -
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CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings
Regulators’ assessment of customer support centers has spurred recent lawsuits from insurers. But the metric “is going to have a smaller weighting on star ratings moving forward,” the director of Medicare said.
By Rebecca Pifer Parduhn • Updated Nov. 15, 2024 -
Samantha Liss/Healthcare Dive
Centene President Ken Fasola to retire next year
Fasola is the second-highest paid executive at the insurer, trailing only CEO Sarah London.
By Rebecca Pifer Parduhn • Nov. 13, 2024 -
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Aetna launched a copay-only health plan. What could it mean for benefits teams?
The plan requires only copays for medical services and prescription drugs up to the plan member’s out-of-pocket maximum, with no deductibles or coinsurance costs.
By Ryan Golden • Nov. 13, 2024 -
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DOJ sues to block UnitedHealth’s $3.3B buy of home health firm Amedisys
The DOJ’s complaint is intentionally broad to maximize its chances of success, according to one expert. Still, the incoming Trump administration could throw cold water on the challenge.
By Rebecca Pifer Parduhn • Nov. 12, 2024 -
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Cigna confirms it is not pursuing Humana acquisition
The flat-out denial comes after Cigna CEO David Cordani tried to discourage persistent speculation of a Humana merger earlier this fall.
By Rebecca Pifer Parduhn • Nov. 11, 2024
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