Payer: Page 21
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CMS launches model to increase primary care investment in Medicare
Value-based care and physician interest groups said the model should create a more stable cash flow for providers.
By Rebecca Pifer • March 20, 2024 -
Courtesy of Kroger
Elevance to buy Kroger’s specialty pharmacy
Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.
By Rebecca Pifer • March 19, 2024 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
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Government watchdog warns of Medicaid oversight gaps
The CMS doesn’t require states to report data on outcomes or care denials, and has made “delayed” progress on plans to analyze the information and make it public, according to the Government Accountability Office.
By Rebecca Pifer • March 18, 2024 -
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Continuous Medicaid enrollment linked to less postpartum coverage loss, study finds
States that have expanded Medicaid for a year after pregnancy might see similar coverage gains, researchers wrote.
By Emily Olsen • March 13, 2024 -
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Elevance completes Paragon Health acquisition
The infusion services and drug therapy company will operate under CarelonRx, Elevance’s pharmacy benefit manager.
By Susanna Vogel • March 11, 2024 -
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Deep DiveWhy Cigna is capping cost increases for pricey GLP-1 weight loss drugs
The move — the first of its kind — comes as pharmacy benefit managers continue to try to prove their value to clients, and shows how major players are shoring up to meet sky-high GLP-1 demand.
By Rebecca Pifer • March 8, 2024 -
Courtesy of UnitedHealth Group
Change Healthcare cyberattackChange says its largest claims clearinghouses coming back online
More than $14 billion in claims have been prepared for processing and will start flowing soon, the technology firm said Friday.
By Emily Olsen • Updated March 25, 2024 -
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Biden proposes strengthening Medicare’s drug pricing power
The administration seeks to significantly increase the number of drugs each year that would be subjected to price negotiations under provisions of the Inflation Reduction Act.
By Kristin Jensen • March 7, 2024 -
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Medicare Advantage beneficiaries receive fewer home health visits, study finds
Medicare Advantage beneficiaries were also less likely to improve self-care and mobility function, according to research published in JAMA Health Forum.
By Emily Olsen • March 5, 2024 -
Permission granted by Elevance Health
Elevance gains $190M on revised MA star ratings
It’s a positive development for the insurer, which sued the government earlier this year after its quality scores fell dramatically.
By Rebecca Pifer • March 5, 2024 -
George Frey / Getty Images Plus via Getty Images
Change Healthcare cyberattackAlphV’s hit on Change Healthcare strikes a sour note for defenders
The ransomware group didn’t just regroup quickly after a law enforcement takedown. It carried out the worst attack on U.S. infrastructure to date, according to experts.
By Matt Kapko • March 4, 2024 -
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Molina loses Medicaid contract in Virginia
It’s the second recent Medicaid state loss for Molina, despite executives expressing confidence about the insurer’s ability to retain contracts.
By Rebecca Pifer • March 1, 2024 -
Permission granted by Elevance Health
Elevance launches weight management program, including GLP-1 monitoring
Elevance joins a growing list of insurers expanding their weight management offerings amid soaring demand for GLP-1 drugs.
By Sydney Halleman • Feb. 28, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth under antitrust investigation by DOJ: reports
Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.
By Rebecca Pifer • Feb. 28, 2024 -
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Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects
Medicare Advantage payment per month per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.
By Rebecca Pifer • Feb. 27, 2024 -
Colin Campbell/Healthcare Dive
State attorneys general urge PBM reform
The letter, sent on behalf of 39 state attorneys general to leaders in Congress, comes as lawmakers consider legislation to regulate the pharmacy middlemen.
By Sydney Halleman • Feb. 23, 2024 -
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Medicare Advantage plans provide less intensive post-acute care, study finds
The research found no differences in 30-day hospital readmissions or mortality, but the study’s authors said more analysis on patients’ long-term functioning was needed.
By Emily Olsen • Feb. 21, 2024 -
Alex Wong via Getty Images
CMS finalizes rule to cut Medicaid DSH payments for some hospitals
Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.
By Susanna Vogel • Updated Feb. 22, 2024 -
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No Surprises implementation created uptick in in-network claims: Fair Health
From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.
By Rebecca Pifer • Feb. 20, 2024 -
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Deep DiveInsurers brace for continued Medicare Advantage medical costs
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.
By Rebecca Pifer • Feb. 20, 2024 -
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Disputes over surprise billing continue to soar, new CMS data shows
Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.
By Rebecca Pifer • Feb. 16, 2024 -
CFO Editorial Staff
SCAN Group, CareOregon abandon merger plans
The insurers have dissolved their merger a little over a year after it was announced amid rising criticism from politicians and the public.
By Susanna Vogel • Feb. 15, 2024 -
Permission granted by Elevance Health
Blue Cross of Louisiana halts sale to Elevance
It's the latest setback for the $2.5 billion deal, which was proposed early last year but has struggled to close amid a lack of buy-in from state regulators.
By Rebecca Pifer • Feb. 15, 2024 -
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Private equity deals in Medicare Advantage decline, report finds
High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project.
By Emily Olsen • Feb. 14, 2024 -
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Humana sued over alleged 340B underpayments in Medicare Advantage
Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.
By Emily Olsen • Feb. 13, 2024
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