Payer: Page 28

  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    Prisma Health files suit against UnitedHealthcare, alleging ‘bad faith’ contract negotiation tactics

    The South Carolina-based health system alleges that the insurer broke its contract and gave "false and misleading" statements to the press about Prisma’s proposed rates for 2024.

    By • Aug. 31, 2023
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    Medicaid cracks down on states over children wrongly losing coverage during redeterminations

    The Biden administration is threatening state Medicaid agencies with sanctions after finding an automation glitch that could cause eligible children to lose coverage.

    By • Aug. 31, 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
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    Employers should focus on provider quality to cut low-value care in plans, report finds

    In the employer-sponsored insurer market, employers play a “critical” role when it comes to quality and outcomes, according to a report by Morgan Health and Embold Health.

    By • Aug. 30, 2023
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    Humana launches in-home senior care program through CenterWell in Georgia, Louisiana

    The program builds on Humana’s acquisition of home-based primary care provider Heal earlier this year, and could expand to 10 additional southern and southwestern states.

    By • Updated Aug. 30, 2023
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Permission granted by Elevance Health
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    Bon Secours sues Anthem BCBS over unpaid claims

    The Cincinnati-based health system is alleging the Elevance subsidiary owes $93 million following four years of contract disputes.

    By • Aug. 29, 2023
  • A stethoscope rests on a medical insurance claim form.
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    Cigna to exit Missouri and Kansas ACA marketplaces in 2024

    The insurer will offer ACA marketplace plans in two fewer states after announcing it would expand its presence on the exchanges last year. 

    By • Aug. 28, 2023
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    Surprise Billing

    Texas judge rules to vacate more No Surprises Act regulations

    The ruling, which targets guidance related to the independent dispute resolution process, prompted the CMS to again pause all federal disputes.

    By • Aug. 28, 2023
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    Shared Savings ACOs saved Medicare $1.8B in 2022

    Nearly two-thirds of participating accountable care organizations earned payments for their performance last year, according to the CMS.

    By • Aug. 25, 2023
  • A view from below of the CVS sign on the center of a building, with a vertical blue HealthHub sign to its right.
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    Mario Tama via Getty Images
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    CVS launches new venture in biosimilar drug experiment

    The subsidiary, called Cordavis, will work directly with manufacturers to market or co-produce low-cost biologic drugs, starting with Novartis’ Humira copy.

    By Jonathan Gardner • Aug. 24, 2023
  • A sign advertises Cigna's free health screenings as the Cigna HIT tour takes to the beach on May 31, 2019 in Virginia Beach, Virginia.
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    Cigna removes prior authorizations for 25% of services

    The insurer also plans to nix another 500 codes for its Medicare Advantage plans before the end of this year.

    By • Aug. 24, 2023
  • A medical professional measures a patient's blood pressure using a sphygmomanometer.
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    Large employers predict pharmacy spend, mental health needs will continue to rise

    “The road ahead for prescription drug and pharmacy looks quite daunting,” said the CEO of the Business Group on Health following a recent survey.

    By • Aug. 23, 2023
  • A doctor talking to a patient and a family member.
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    MA beneficiaries like their plans, but few say it’s easy to find care

    Trust and the ability to resolve problems or complaints were factors most highly correlated with members’ likelihood of renewing their plans, according to a new J.D. Power study.

    By • Aug. 23, 2023
  • A view of the historic Old Florida State Capitol building, which sits in front of the current New Capitol, on November 10, 2018 in Tallahassee, Florida.
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    Mark Wallheiser via Getty Images
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    Florida sued over Medicaid redeterminations

    Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicaid coverage without proper notice.

    By • Aug. 23, 2023
  • A picture of the exterior of a CVS Pharmacy with the logo and name in view.
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    Bruce Bennett via Getty Images
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    CVS layoffs hit Rhode Island, Connecticut, New York and more

    The layoffs disclosed late last week to state labor departments include 770 employees in CVS’ Rhode Island headquarters, and about 520 workers at health insurer Aetna’s Connecticut hub.

    By • Aug. 21, 2023
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    Ground ambulance billing committee skeptical of IDR process

    A key congressional advisory group met last week to deliberate preventing unexpected bills after medical transport, but said the status quo dispute resolution process isn’t the solution.

    By • Aug. 17, 2023
  • A picture of the exterior of a CVS Pharmacy with the logo and name in view.
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    Bruce Bennett via Getty Images
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    Blue Shield of California drops CVS Caremark in pharmacy benefit overhaul

    BSCA has kicked CVS Caremark, the largest pharmacy benefit manager in the country, to the curb and is electing to carve out various pharmacy functions with companies like Amazon instead.

    By • Updated Aug. 17, 2023
  • Grocery items including quiche, orange juice, a floral bouquet and sweet kale, on a table at a grocery store.
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    Courtesy of Kroger
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    Kroger, Intermountain subsidiary Select Health launch co-branded MA plan

    It's the grocery chain's third MA plan in partnership with a health insurer. Kroger also operates plans with Elevance and Priority Health.

    By • Aug. 16, 2023
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    Alex Wong via Getty Images
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    CMS tweaks ACO REACH to stabilize model

    Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to form groups to manage care and costs for fee-for-service Medicare enrollees.

    By • Aug. 15, 2023
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    Deep Dive

    Will the Biden administration’s short-term plan rule increase the uninsured rate?

    Free-market advocates argue proposed restrictions on short-term plans will leave consumers without coverage. Health policy researchers aren’t so sure.

    By • Aug. 14, 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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    AdventHealth sues MultiPlan for alleged ‘cartel’ with health insurers to fix prices

    The health system alleges providers have lost at least $19 billion per year as a direct result of MultiPlan’s anticompetitive agreements with major payers, including UnitedHealth, Aetna and Elevance.

    By • Aug. 14, 2023
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    UnitedHealth Group
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    DOJ hits UnitedHealth, Amedisys with second request over $3.3B deal

    The request for more information pushes back the timeline of the merger as regulators take a more active stance in healthcare M&A oversight.

    By • Aug. 11, 2023
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    MA bonuses reach record high, with UnitedHealthcare, Humana biggest winners

    Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.

    By • Aug. 10, 2023
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    Hospital prices twice as high for commercial plans than MA when negotiated by same payer, study finds

    Large national insurers had higher price ratios than other payers, an analysis in Health Affairs found.

    By • Aug. 9, 2023
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    Smaller insurers tout progress toward profitability in Q2

    Clover notched its first quarterly adjusted EBITDA profit as a public company, while Oscar reached total company profitability for the second quarter in a row. Meanwhile, Bright posted its first quarter ever with positive adjusted EBITDA.

    By • Aug. 9, 2023
  • a picture of a red stethoscope on top of a US billed money.
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    Adeline Kon/Healthcare Dive/Healthcare Dive
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    5 takeaways from health insurers’ second-quarter earnings

    UnitedHealth, CVS, Elevance and peers sidestepped the worst of medical cost growth in the quarter, but many payers face uncertainty from Medicare Advantage star ratings, GLP-1s and other pressures.

    By • Aug. 8, 2023