Payer: Page 21
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MedPAC backs tying physician pay to inflation, but ducks specifics
During a meeting Thursday, commissioners debated different solutions to lackluster physician pay with one theme in common: linking doctors’ annual payment update to the Medicare Economic Index.
By Rebecca Pifer Parduhn • Nov. 8, 2024 -
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How the healthcare industry is reacting to a second Trump term
Donald Trump’s first term as president was characterized by significant turbulence for government healthcare programs. Here’s how some of the most influential industry groups responded to the Republican’s reelection.
By Rebecca Pifer Parduhn • Nov. 7, 2024 -
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CVS appoints new Aetna head following mixed third-quarter results
This year has been defined by an unsuccessful fight against elevated medical costs for CVS. The third quarter was no different.
By Rebecca Pifer Parduhn • Nov. 6, 2024 -
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Few state Medicaid programs cover GLP-1s for obesity: KFF
Still, gross spending on the drugs increased by more than 500% from 2019 to 2023, according to the health policy research firm.
By Emily Olsen • Nov. 6, 2024 -
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MACPAC calls for greater transparency amid steep rise in Medicaid directed payments
Dramatic growth in an opaque Medicaid funding mechanism is exacerbating concerns about the program’s fiscal integrity — while spurring financial gains for the hospital industry.
By Rebecca Pifer Parduhn • Nov. 5, 2024 -
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Surprise BillingFederal government notches rare win in surprise billing lawsuit
Last week, the 5th Circuit Court of Appeals sided with the federal government’s original interpretation of the No Surprises Act in determining how a key metric in billing disputes is calculated.
By Sydney Halleman • Nov. 5, 2024 -
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Elevance Health sues HHS over Medicare Advantage star ratings
The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.
By Emily Olsen • Nov. 4, 2024 -
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Sponsored by VeradigmClosing the gaps: Enhancing patient outcomes through effective care gap management
Unlock better patient outcomes by identifying and closing critical gaps in care.
By Joseph Ryan • Nov. 4, 2024 -
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Medicare saves record $2.1B from largest accountable care program
Citrus ACO in Central West Florida had the highest savings rate, while Health Connect Partners — an ACO operated by hospital giant Providence — had the highest total savings in the Medicare Shared Savings Program last year.
By Rebecca Pifer Parduhn • Oct. 31, 2024 -
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Cigna CEO tamps down on Humana deal speculation
Despite reports this fall that the two payers had reopened merger talks, Cigna plans to use excess cash to buy back its shares, David Cordani told investors.
By Rebecca Pifer Parduhn • Oct. 31, 2024 -
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Humana boosts 2024 earnings guidance thanks to Medicare Advantage member retention
The insurer said it doesn’t expect earnings growth next year due to significant investments it plans to make to boost MA stars.
By Rebecca Pifer Parduhn • Oct. 30, 2024 -
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Rising healthcare costs could trickle down to workers: employer survey
Employers said higher drug costs pose the biggest threat to healthcare affordability, according to the National Alliance of Healthcare Purchaser Coalitions report.
By Rebecca Pifer Parduhn • Oct. 30, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth Group names new CISO 8 months after massive ransomware attack
UnitedHealth Group declined to say if the leadership change came in response to a February ransomware attack that brought the company’s medical claims and processing platform down for more than a month.
By Matt Kapko • Oct. 30, 2024 -
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Centene beats investor expectations despite Medicaid headwinds
Like other payers, Centene flagged a mismatch between patient acuity and payment rates in Medicaid. But the insurer said a diversified portfolio helped it navigate challenges in the third quarter.
By Emily Olsen • Oct. 26, 2024 -
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AMA sues MultiPlan, insurers, alleging ‘cartel’ to fix physician prices
MultiPlan, which denies the allegations, has been sued dozens of times over concerns the company is conspiring with health insurers to underpay doctors for out-of-network care.
By Rebecca Pifer Parduhn • Oct. 25, 2024 -
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Employees are asking about GLP-1 coverage. What should employers do?
GLP-1 coverage needs to be holistic to ensure long-term success, experts said.
By Caroline Colvin • Oct. 24, 2024 -
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HLTH24‘AI arms race’ underway as payers, providers jockey for upper hand in claims review
Payers currently have a leg up when using AI to review claims, but providers could soon catch up, experts say.
By Susanna Vogel • Oct. 24, 2024 -
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State Medicaid directors concerned about program’s stability: KFF
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
By Rebecca Pifer Parduhn • Oct. 24, 2024 -
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Molina ‘beating the odds’ in Medicaid
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.
By Rebecca Pifer Parduhn • Oct. 24, 2024 -
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Insurer lobby blames government policies for 2025 Medicare Advantage market makeup
The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.
By Rebecca Pifer Parduhn • Oct. 23, 2024 -
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Centene sues HHS over Medicare Advantage star ratings fall
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.
By Rebecca Pifer Parduhn • Oct. 23, 2024 -
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HLTH24PBM model is a ‘dead man walking.’ What comes next?
Executives from Amazon, Walgreens, Blue Shield of California and PhRMA weighed in on how to fix the much-scrutinized pharmacy benefit manager model during HLTH 2024.
By Susanna Vogel • Oct. 23, 2024 -
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HLTH24Blue Shield of California partners with Salesforce to automate prior authorization
The collaboration comes amid controversy about claims automation technology. Paul Markovich, CEO of Blue Shield of California, promised to keep a "human in the loop" to oversee any denials.
By Susanna Vogel • Oct. 22, 2024 -
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Humana sues HHS over calamitous Medicare Advantage star ratings decrease
It’s the latest in a string of lawsuits from health insurers scrambling to protect their prized quality scores and the money those ratings represent.
By Rebecca Pifer Parduhn • Oct. 21, 2024 -
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Senate report slams Medicare Advantage insurers for using predictive technology to deny claims
UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.
By Susanna Vogel • Oct. 21, 2024
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