Dr. Oz vows to scrutinize Medicare Advantage as CMS head

Mehmet Oz, who previously advocated for expanding the privatized Medicare program, said he would tackle upcoding among MA plans if confirmed.

By Emily Olsen • March 17, 2025

CMS nominee Dr. Oz says he supports Medicaid work requirements

Republicans are considering tying eligibility in the safety-net program to work, volunteer or education hours to meet spending targets.

By Emily Olsen • March 14, 2025

Explore the 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

Nevada announces intent to award Medicaid contracts

The Silver State plans to award managed care contracts to newcomer CareSource and incumbents UnitedHealth, Elevance, Centene and Molina.

By Rebecca Pifer Parduhn • March 14, 2025

CMMI cancels 4 payment models early

The CMS estimates terminating the models will save nearly $750 million. The agency will also no longer implement two demonstrations that aimed to improve prescription drug affordability and access.

By Emily Olsen • March 13, 2025

Cigna reshuffles C-suite amid rising costs

Cigna promoted Brian Evanko to chief operating officer and named a new chief financial officer in his place, while Eric Palmer will be leaving the company as an apparent victim of the restructuring.

By Rebecca Pifer Parduhn • March 13, 2025

Medicaid expansion cuts could hit provider revenue, spike uncompensated care: report

If states end their expansion programs in response to funding cuts, spending on healthcare services would fall by nearly $80 billion and uncompensated care costs would rise by $19 billion in 2026, according to new research.

By Emily Olsen • March 12, 2025

Trump administration proposes ACA program integrity rule that would decimate enrollment

The rule is like “making people crawl through broken glass” for health insurance, one expert said.

By Rebecca Pifer Parduhn • March 11, 2025

Republicans can’t meet budget target without Medicaid cuts: CBO

Excluding large health insurance programs, spending under the House Energy and Commerce Committee's purview falls far short of the budget blueprint’s $880 billion goal for cuts.

By Emily Olsen • March 10, 2025

Vertex’s new pain drug gets first coverage nod from major insurer

Optum Rx, the pharmacy benefit manager owned by UnitedHealth Group, placed Journavx on some of its commercial formularies in an interim decision while a formal review continues.

By Jacob Bell • March 6, 2025

EHR vendors turn to artificial intelligence to modernize health records

Software companies like Epic and Oracle say they’re weaving AI into clinicians’ workflows to meet client demand, keep up with competitors and improve the productivity of a swamped healthcare system.

By Rebecca Pifer Parduhn • March 6, 2025

Older, self-employed enrollees more likely to lose ACA subsidies if enhanced tax credits lapse: KFF

Beneficiaries who earn more than four times the federal poverty level wouldn’t be eligible for any subsidies on marketplace plans if the enhanced premium tax credits expire at the end of the year.

By Emily Olsen • March 5, 2025

CVS sells Medicare Shared Savings business to Wellvana

The all-stock deal gives CVS a strategic minority investment in value-based care services firm Wellvana.

By Emily Olsen • March 5, 2025

Loss of enhanced ACA subsidies could batter state economies: report

Overall employment could fall by 286,000 jobs next year if the enhanced premium tax credits lapse, including 130,000 lost roles in the healthcare sector.

By Emily Olsen • March 4, 2025

Trump administration policies could create headwinds across healthcare: Fitch

The credit ratings agency is most concerned about Medicaid cuts and how government layoffs will affect device approvals.

By Susanna Vogel • March 3, 2025

[Podcast] The Payer Pod: Empowering Health Plans for Success in 2025

This podcast series explores the market forces impacting payers right now, how to reduce friction for providers, and ways to elevate member engagement.

Feb. 28, 2025

Federal Medicaid cuts could shift $44.3B in costs to expansion states

The 41 states that expanded Medicaid could be asked to spend 25% more to cover care costs if potential cuts are approved by Congress. Some states may cut the expansion program instead.

By Susanna Vogel • Feb. 27, 2025

Medicare Advantage growth slows as UnitedHealthcare nabs members, Humana sheds lives

The CMS released highly anticipated MA enrollment data on Tuesday that showed UnitedHealth further tightening its grip on the privatized Medicare market.

By Rebecca Pifer Parduhn • Feb. 26, 2025

Centene expands board with former Prudential finance chief

The appointment of Kenneth Tanji brings the number of directors on Centene’s board to 12.

By Emily Olsen • Feb. 26, 2025

House Republicans pass budget blueprint that could spell Medicaid cuts

Although the budget resolution does not mention Medicaid specifically, lawmakers would be hard pressed to find enough cuts to meet an $880 billion target without touching federal healthcare programs.

By Sydney Halleman • Feb. 26, 2025

Insurers closed out 2024 on shaky footing

Operating income fell for all but two major payers’ insurance divisions in the fourth quarter. And 2025 may be no better, after many insurers released outlooks suggesting medical costs will continue to rise.

By Rebecca Pifer Parduhn • Feb. 25, 2025

Physicians say prior authorization stands in the way of medically necessary care

Physicians surveyed by the American Medical Association say prior authorization can cause care delays or force patients to abandon treatment. Denials could also increase as insurers adopt AI to review claims.

By Susanna Vogel • Feb. 25, 2025

Express Scripts, Caremark, Optum Rx plan to appeal effort to block FTC lawsuit

The “Big Three” PBMs are kicking their suit up to the 8th Circuit and, in the meantime, are once again asking a Missouri district judge to halt the FTC’s administrative case against them.

By Rebecca Pifer Parduhn • Feb. 24, 2025

Medicaid cuts could worsen home care worker shortage: KFF

States have increased provider payment rates to address workforce shortages, but they may have to cut back if spending cuts hit Medicaid, according to the health policy researcher.

By Emily Olsen • Feb. 20, 2025

FTC case against Caremark, Express Scripts, Optum Rx can move forward, judge rules

A Missouri district court judge on Tuesday said stopping the FTC’s suit against the Big Three PBMs would be “against the public’s interest.” 

By Rebecca Pifer Parduhn • Feb. 20, 2025

Humana plans to add up to 30 more primary care centers this year

The new centers are being built or acquired in 11 of the 15 states where Humana’s primary care network already has a presence.

By Rebecca Pifer Parduhn • Updated Feb. 19, 2025