Payer: Page 24

  • pharmacist scanning prescription
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    CMS asks health plans, PBMs to ease up on independent pharmacies

    A new letter urges payers to put in place special payment arrangements with pharmacies before a new policy kicks in that could reduce how much pharmacies are paid upfront.

    By • Dec. 15, 2023
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    Health spending growth normalized in 2022 post-COVID, CMS says

    Healthcare spending grew 4.1% in 2022, faster than 2021’s growth but notably slower than 2020’s, according to government actuaries.

    By • Dec. 14, 2023
  • Explore the Trendline➔
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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
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss/Healthcare Dive
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    Centene tries to quell concerns of ACA overhaul during investor day

    The Affordable Care Act has been under fire from Republican presidential candidates heading into an election year. But “once you giveth you cannot taketh away,” said the head of external affairs for the major marketplace carrier.

    By • Dec. 13, 2023
  • Humana
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    Courtesy of Humana
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    Humana used algorithm to deny care to Medicare Advantage patients, lawsuit claims

    The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.

    By • Dec. 13, 2023
  • A picture of the US Capitol building with the American flag waving in front of it
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    Samuel Corum/Getty Images via Getty Images
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    House passes bill targeting price transparency, site-neutral payments, PBMs

    Hospitals have lobbied against the site-neutral payment policies included in the bipartisan legislation.

    By • Dec. 12, 2023
  • CFOs should carefully assess their vendor choices to improve the quality of care for employees and decrease the cost curve.
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    Health costs grew in line with overall inflation in 2023, new Turquoise data shows

    The findings — some of the first from new price transparency data — illustrate how overall economic inflation could be catching up to faster health cost growth.

    By • Dec. 12, 2023
  • A Cigna logo behind a construction fence.
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    Matt Slocum/AP

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    Cigna pulls out of Humana deal: WSJ

    Cigna and Humana are abandoning merger discussions less than two weeks after news of the potential deal dropped, following a less-than-positive market reaction.

    By • Dec. 11, 2023
  • Flyer for Kroger Health on a table.
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    Catherine Douglas Moran/Healthcare Dive
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    Kroger’s new benefits program expands access to affordable food

    The tie-up with a healthcare technology company lets Medicare Advantage, Medicaid and other employer benefits program recipients use services at the grocer’s pharmacies as well as buy eligible food and over-the-counter items. 

    By Catherine Douglas Moran • Dec. 7, 2023
  • An illustration of a stethoscope in the shape of a dollar sign.
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    Clover Health exits ACO REACH

    The beleaguered insurer will leave the accountable care program at the end of the 2023 performance year following disappointing results in Medicare direct contracting.

    By • Dec. 6, 2023
  • Text of the word 'Medicaid' in the middle of a U.S. dollar bill
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    CMS says states could lose funding over Medicaid redeterminations issues

    The interim final rule comes as nearly 11.8 million people have been removed from the safety-net insurance.

    By • Dec. 5, 2023
  • CVS storefront
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    Scott Olson via Getty Images
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    CVS overhauls how its retail pharmacies charge for prescription drugs

    Under the new model, CVS’ pharmacy network will price drugs based on the amount the company paid for them, plus a defined markup and additional pharmacist fee.

    By • Dec. 5, 2023
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    Deep Dive

    A Cigna-Humana merger could face a long regulatory delay. But it might get approved.

    As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.

    By • Dec. 4, 2023
  • Elevance Health executive, Geeta Wilson, and vice president, Jenn Wade, discuss the future of healthcare customer service on June 10, 2023, at the PegaWorld iNspire conference in Las Vegas.
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    Permission granted by Pegasystems
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    Sponsored by Pegasystems

    Enhanced human potential: How customer service technology increases empathy

    Elevance Health’s Geeta Wilson talks about improving operational efficiencies while enhancing member and associate satisfaction.

    By Christopher Patterson, VP Product Strategy, Pegasystems • Dec. 4, 2023
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    North Carolina Medicaid expansion kicks in

    About 600,000 more people in the state now have access to the safety-net insurance coverage.

    By • Dec. 1, 2023
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook

    UnitedHealth’s MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers, management said during an investor day.

    By • Nov. 30, 2023
  • An illustration of a large dollar coin with medical supplies flying in the foreground is positioned on an analysis tracking chart background.
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

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    Highmark Health’s insurance business boosts earnings

    The insurance arm pushed the healthcare parent company to positive results during the first nine months of 2023 after its provider arm, Allegheny Health, reported an operating loss.

    By • Nov. 29, 2023
  • A Cigna logo behind a construction fence.
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    Matt Slocum/AP

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    Cigna, Humana in talks to merge: WSJ

    The merger would have major effects on the makeup of the U.S. health insurance industry, and would almost certainly face a regulatory challenge.

    By • Nov. 29, 2023
  • Stethoscope lying on top of dollar bills
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    Global medical costs to dip in 2024 — but respite may not last long, research finds

    Medical costs will continue to rise over the next few years, according to WTW. Surveyed insurers blamed expensive medical technologies and an overuse of health services.

    By • Nov. 29, 2023
  • A stethoscope rests on a pile of American dollar bills.
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    Majority of Medicaid enrollees satisfied with plans, despite flaws, survey finds

    Medicaid enrollees are more likely to understand and be satisfied with their plans, despite reporting poorer health outcomes, according to a new report from KFF. 

    By • Nov. 29, 2023
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    Sponsored by Pegasystems

    AI to take center stage in healthcare in 2024

    Five predictions on how AI will change healthcare.

    By Robert Connely, Global Market Leader for Healthcare, Pegasystems • Nov. 27, 2023
  • A birds-eye picture of a stethoscope and piggy bank against a blue background
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    Average per-worker cost of health benefits rose by 5.2% in 2023: survey

    Inflation is a contributor to the increase, but rising prescription drug costs are likely to have a longer-term impact, according to a Mercer report.

    By • Nov. 22, 2023
  • A stethoscope rests on a medical insurance claim form.
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    Insurers’ financial outlook stable despite higher MA utilization: Moody’s

    Publicly traded health insurers’ financial results held steady in the third quarter, boosted by strong investment income and membership growth, according to the credit ratings agency.

    By • Nov. 22, 2023
  • 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 proposes stricter network adequacy standards for plans in state-run ACA exchanges

    Beginning in 2025, plans sold in state-based exchanges would be required to meet time and distance standards for provider access under a new rule proposed Wednesday.

    By • Nov. 16, 2023
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss/Healthcare Dive
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    Centene names new COO following leadership turnover

    Current SVP Susan Smith will take the reins as the health insurer’s chief operating executive starting next year.

    By • Nov. 15, 2023
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    UnitedHealth sued over use of algorithm to deny care for MA members

    The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.

    By • Nov. 15, 2023