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UnitedHealth, Cigna, CVS sue FTC over insulin litigation process
The three companies are claiming the FTC’s suit is unconstitutional because it was lodged in the agency’s administrative court, instead of a federal one.
By Rebecca Pifer Parduhn • Nov. 20, 2024 -
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CMS allows 5 states to adopt multiyear continuous Medicaid eligibility for children
The future of such policies is unclear under an upcoming Trump administration, which could rescind approvals or prevent states from implementing waivers.
By Emily Olsen • Nov. 20, 2024 -
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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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Oak Street Health co-founder departs CVS
Mike Pykosz, who joined CVS with its acquisition of the value-based medical chain in 2023, is departing amid a flurry of high-level ousters at the struggling company. However, Pykosz is leaving voluntarily, CVS said.
By Rebecca Pifer Parduhn • Nov. 20, 2024 -
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If enhanced ACA subsidies expire, 4M could become uninsured: report
The enhanced premium tax credits will expire at the end of next year without action from lawmakers. Republicans have previously criticized the subsidies’ cost.
By Emily Olsen • Nov. 19, 2024 -
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Offering health insurance is becoming less lucrative
In the third quarter, the seven major publicly traded insurers’ medical loss ratios increased an average of 3.3 percentage points year over year — a major jump in medical costs.
By Rebecca Pifer Parduhn • Nov. 18, 2024 -
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Top CMS official urges Trump administration to treat Medicaid with care
“Do to others what you would want done to yourself,” Medicaid director Daniel Tsai said Thursday when asked about advice for his replacement in Trump’s HHS. Trump is expected to cut Medicaid eligibility and funding.
By Rebecca Pifer Parduhn • Nov. 14, 2024 -
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CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings
Regulators’ assessment of customer support centers has spurred recent lawsuits from insurers. But the metric “is going to have a smaller weighting on star ratings moving forward,” the director of Medicare said.
By Rebecca Pifer Parduhn • Updated Nov. 15, 2024 -
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Centene President Ken Fasola to retire next year
Fasola is the second-highest paid executive at the insurer, trailing only CEO Sarah London.
By Rebecca Pifer Parduhn • Nov. 13, 2024 -
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Aetna launched a copay-only health plan. What could it mean for benefits teams?
The plan requires only copays for medical services and prescription drugs up to the plan member’s out-of-pocket maximum, with no deductibles or coinsurance costs.
By Ryan Golden • Nov. 13, 2024 -
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DOJ sues to block UnitedHealth’s $3.3B buy of home health firm Amedisys
The DOJ’s complaint is intentionally broad to maximize its chances of success, according to one expert. Still, the incoming Trump administration could throw cold water on the challenge.
By Rebecca Pifer Parduhn • Nov. 12, 2024 -
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Cigna confirms it is not pursuing Humana acquisition
The flat-out denial comes after Cigna CEO David Cordani tried to discourage persistent speculation of a Humana merger earlier this fall.
By Rebecca Pifer Parduhn • Nov. 11, 2024 -
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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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