Payer: Page

  • Cone Health's flagship hospital Mose
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    Courtesy of Cone Health
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    Cone fully acquires Medicare Advantage plan from Novant

    Novant has sold its minority stake in HealthTeam Advantage back to Cone Health, which is focusing on growing its insurance offerings.

    By • April 16, 2025
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    UnitedHealth to enter mediation with DOJ over Amedisys deal

    This summer, UnitedHealth, Amedisys and antitrust regulators will have a magistrate judge’s help in hashing out a solution to the DOJ’s opposition to the merger.

    By • April 15, 2025
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    Yujin Kim/Healthcare Dive
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    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 birds-eye picture of a stethoscope and piggy bank against a blue background
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    Many CMMI models didn’t generate savings: report

    Only one-third of the models analyzed produced substantial savings for the federal government, according to Avalere Health. The payment models have become a target for spending reductions under the Trump administration.

    By Emily Olsen • April 14, 2025
  • A picture of the exterior of the US Department of Health and Human Services. In front of the building is a black sign designating the building's name.
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    Alex Wong via Getty Images
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    CMS to end some federal Medicaid spending for state health programs

    The decision represents “the end of an era of being open to a broader conception of health within the Medicaid program,” one expert said.

    By Emily Olsen • April 14, 2025
  • The HHS in DC
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    Alex Wong via Getty Images
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    Medicare proposes 2.4% pay hike for inpatient hospitals next year

    The rate increase is the lowest since 2019. The American Hospital Association slammed it as inadequate.

    By • April 14, 2025
  • House Speaker Mike Johnson, R-La., speaks to reporters after the House passes the Republicans' budget plan at the U.S. Capitol on April 10, 2025 in Washington, D.C.
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    Andrew Harnik/Getty Images via Getty Images
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    House adopts budget plan that could cue Medicaid cuts

    Now, lawmakers will hash out legislation that follows the spending blueprint, which could include cuts to the safety-net insurance program — a potentially unpopular choice among Republican voters.

    By Emily Olsen • April 10, 2025
  • a medicaid insurance card on top of a small American flag
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    Medicaid cuts unpopular with Trump voters: poll

    More than 50% of Trump voters oppose cutting Medicaid to pay for tax cuts, according to a GOP pollster. The survey suggests the issue could be politically challenging for Republican lawmakers.

    By Emily Olsen • April 9, 2025
  • Shot of CVS Pharmacy logo
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    Mario Tama via Getty Images
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    CVS taps former UPS finance chief as new CFO

    Brian Newman will guide CVS’ finances at a challenging time for the retail pharmacy and health insurance giant. Still, CVS also said on Tuesday it could exceed previously issued guidance in 2025.

    By Emily Olsen • April 8, 2025
  • A sign for the U.S. Department of Health and Human Services stands outside of a concrete building.
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    Ned Pagliarulo/Healthcare Dive
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    Trump’s CMS dramatically raises payments to Medicare Advantage plans

    The 5.1% benchmark increase is the largest in the past decade. The hike reflects more recent data capturing cost growth, according to the CMS. Though, the Trump administration likely “had its finger on the scale,” one analyst said.

    By • April 8, 2025
  • A piece of paper with the word "Medicare" emblazoned on a blue background
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    Getty Images
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    Trump rejects Biden administration plan to let Medicare cover obesity drugs

    The decision is a setback for GLP-1 drugmakers, though it's not entirely surprising given the Trump administration’s focus on curbing government spending.

    By • April 7, 2025
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    UnitedHealth shareholders withdraw effort to force transparency on coverage denials

    The faith-based shareholders’ proposal was challenged by UnitedHealth twice, thanks to a recent SEC guidance change the shareholders slammed as unfair. They could still reintroduce it next year.

    By • April 7, 2025
  • Dr. Mehmet Oz arrives for his confirmation hearing with the Senate Finance Committee in the Dirksen Senate Office Building on March 14, 2025 in Washington, D.C.
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    Anna Moneymaker / Staff via Getty Images
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    Dr. Oz confirmed to lead CMS

    Dr. Mehmet Oz, a physician and TV personality, will lead the agency during a turbulent time for federal health programs as the HHS lays off thousands of staffers and Republicans float potential cuts to Medicaid.

    By Emily Olsen • Updated April 4, 2025
  • A closeup of an entryway that reads the Federal Trade Commission.
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    Getty Images
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    FTC pauses PBM litigation in win for Caremark, Express Scripts, Optum Rx

    The FTC says it doesn’t have enough active commissioners to move forward after President Donald Trump fired two Democrats last month.

    By • April 3, 2025
  • A sign reading OBAMACARE hangs outside a storefront.
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    Joe Raedle via Getty Images
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    ACA enrollment increase driven by growth in states won by Trump: KFF

    Sign-ups for coverage on the Affordable Care Act exchanges have more than doubled since 2020. Enrollment was particularly concentrated in states won by President Donald Trump in last year’s election.

    By Emily Olsen • April 2, 2025
  • Text of the word 'Medicaid' in the middle of a U.S. dollar bill
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    Advocacy groups say Medicaid cuts would be ‘catastrophic’

    In a letter to Senate Majority Leader John Thune, hundreds of groups said the potential cuts would “shred our nation’s social safety net,” delaying access to care and ultimately driving up healthcare costs.

    By Emily Olsen • March 28, 2025
  • An exterior shot of the Department of Justice building shows the words "Department of Justice" and an American flag flying above.
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    Kevin Dietsch / Staff via Getty Images
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    DOJ backs up providers in suit against Claritev

    Claritev, formerly known as MultiPlan, is being accused of conspiring with insurers to lower reimbursement for providers. The DOJ agrees, filing a statement of interest in the consolidated suit against the cost management firm.

    By • March 26, 2025
  • A picture of Mehemet Oz sitting behind a table in a Senate hearing room.
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    Anna Moneymaker/Getty Images via Getty Images
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    Senate committee advances Dr. Oz to lead CMS

    Democrats on the Senate Finance Committee criticized the physician and TV personality ahead of the vote Tuesday for avoiding questions about potential cuts to Medicaid.

    By Emily Olsen • March 26, 2025
  • A sign reads "Wells Fargo" outside of a Wells bank branch.
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    Michael M. Santiago / Staff via Getty Images
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    Judge dismisses lawsuit against Wells Fargo over prescription drug costs

    The decision could throw cold water on potential copycat suits seeking to hold large, self-funded employers responsible if they overpay for prescription drugs.

    By • March 26, 2025
  • a medicaid insurance card on top of a small American flag
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    Medicaid, SNAP cuts could lead to 1 million jobs lost in 2026: report

    Reducing spending on Medicaid and the food assistance program could batter state economies and lead to job cuts — including 477,000 roles in in the healthcare sector alone, according to the Commonwealth Fund.

    By Emily Olsen • March 25, 2025
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    GLP-1s are accelerating spending growth on traditional drugs, Evernorth research finds

    Spending growth for simple medications used to treat common health problems is outstripping spending growth for pricey medications used to treat complex and chronic conditions, according to a new report from a Cigna subsidiary.

    By • Updated March 25, 2025
  • Bottles and cartons of prescription medicines are arranged on shelves.
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    Spencer Platt via Getty Images
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    Optum Rx is reforming how it pays pharmacies

    The massive PBM is pivoting to a cost-based reimbursement model, which it says will reduce variation in how pharmacies are paid. Pharmacy groups say that depends on the specifics of Optum Rx’s plan.

    By • March 21, 2025
  • Cigna's logo is seen on a door.
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    Julia Rendleman via Getty Images
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    Cigna closes $3.7B sale of Medicare business to HCSC

    The deal, which removes Cigna from the volatile Medicare Advantage market, closed a little over a year after being announced.

    By • March 20, 2025
  • A picture of a form that says 'Medicaid eligibility'
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    Getty Images
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    Medicaid work requirements could cut coverage for 5.2M

    A new report found that millions could lose access to care, even though most Medicaid beneficiaries are working or should be eligible for exemptions from work requirements.

    By Susanna Vogel • Updated March 24, 2025
  • Cigna's logo is seen on a door.
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    Julia Rendleman via Getty Images
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    Jefferson Health goes out of network for Cigna commercial members following contract spat

    The Philadelphia-area system and major insurer have failed to reach a new agreement on payment rates, but are still continuing negotiations.

    By • March 19, 2025
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    Optum Rx says it will eliminate 10% of prior authorizations

    The massive pharmacy benefit manager plans to stop requiring coverage reauthorizations for roughly 80 drugs used to treat migraines, multiple sclerosis, high cholesterol and more.

    By • March 19, 2025