Payer: Page 29
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Permission granted by Elevance Health
Elevance snags Moody’s exec for new CFO
Current CFO John Gallina is leaving Elevance after almost three decades in various leadership roles, including seven years as CFO.
By Rebecca Pifer • Aug. 8, 2023 -
Mark Wilson via Getty Images
Texas judge rules in favor of doctors in latest suit over surprise billing process
The decision is expected to increase the number of claims providers file in the independent dispute resolution process, especially for smaller amounts, according to a health lawyer.
By Rebecca Pifer • Aug. 7, 2023 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
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 -
Former CMS, BCBS exec steps up as CEO of OptumRx in UnitedHealth leadership shakeup
In a chain reaction of executive moves, Patrick Conway is replacing Heather Cianfrocco as CEO of UnitedHealth’s pharmacy benefit manager.
By Rebecca Pifer • Aug. 4, 2023 -
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Health insurers ignore surprise billing decisions, providers allege
Payers didn’t reimburse doctors in more than half of arbitration award cases, according to a survey from clinician group Americans for Fair Health Care.
By Rebecca Pifer • Aug. 4, 2023 -
Joe Raedle/Getty Images via Getty Images
Kentucky sues major PBMs over rising insulin prices
A string of states and cities have filed recent suits against PBMs and drug manufacturers alleging they work in tandem to raise the cost of insulin.
By Sydney Halleman • Aug. 4, 2023 -
Julia Rendleman via Getty Images
Cigna checks medical cost growth as Evernorth earnings boosted by GLP-1s
Cigna’s medical costs in the quarter were “well-controlled,” one analyst said, but faced pressure from higher estimated risk-adjustment payments in the ACA individual exchanges.
By Rebecca Pifer • Aug. 3, 2023 -
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U.S reaches record low uninsured rate just prior to Medicaid redeterminations
The uninsured rate fell to a record low in March, but Medicaid eligibility checks could reverse that progress, according to experts.
By Susanna Vogel • Aug. 3, 2023 -
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UnitedHealth unit sued by Labor Department over systematic claims denials
The government is alleging plan administrator UMR improperly denied thousands of ER and drug screening claims submitted between 2015 and 2018.
By Susanna Vogel • Aug. 2, 2023 -
Justin Sullivan via Getty Images
CVS announces restructuring plan after profit falls 37%
CVS also lowered its 2024 earnings outlook, citing cost pressures, and said investors should no longer rely on its 2025 target.
By Rebecca Pifer • Aug. 2, 2023 -
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Humana reports lower-than-feared medical costs, raises MA membership growth outlook
Humana’s stock rose following the earnings, which — along with comments from other payers — suggest the uptick in outpatient care flagged earlier in the quarter is moderating.
By Rebecca Pifer • Aug. 2, 2023 -
Scott Olson via Getty Images
CVS to lay off 5K employees amid cost pressures
The job cuts come as CVS faces hefty integration costs from recent M&A, including its $10.6 billion buy of Oak Street and $8 billion acquisition of Signify.
By Rebecca Pifer • Aug. 1, 2023 -
Permission granted by Elevance Health
Elevance rebrands Amerigroup segment as Wellpoint
The return of the Wellpoint brand for Amerigroup, which covers Medicaid and Medicare members, is the payer's latest corporate reinvention.
By Rebecca Pifer • Aug. 1, 2023 -
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Hospital, payer lobbies urge CMS to reconsider ‘conflicting’ prior authorization standards
The groups, normally at odds, have found a source of agreement in proposed rules meant to standardize data exchange processes.
By Brian T. Horowitz • July 31, 2023 -
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CMS releases April Medicaid unwinding data. Total disenrollments top 3.8M
The highly-anticipated data pegging the nation’s procedural disenrollment rate at 80% is higher than more recent estimates.
By Rebecca Pifer • July 28, 2023 -
Samantha Liss/Healthcare Dive
Centene’s 2024 outlook hampered by Medicaid redeterminations
The payer lost 262,700 Medicaid members in the second quarter, dropping its total Medicaid lives to just over 16 million.
By Rebecca Pifer • July 28, 2023 -
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Nevada to shut down Friday Health Plans
State regulators will liquidate the failing insurtech, leaving about 3,000 enrollees to look for new coverage.
By Emily Olsen • July 27, 2023 -
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Molina reports Medicaid redeterminations proceeding as expected
Despite concerns about high early levels of disenrollments, the payer lost 93,000 Medicaid members during the second quarter — well within forecasts, CEO Joe Zubretsky said.
By Rebecca Pifer • July 27, 2023 -
Drew Angerer / Staff via Getty Images
Microsoft, Blue Shield partner to develop integrated data hub
The hub, which the companies are calling “The Blue Shield Experience Cube,” will create an integrated digital health record as its first use case.
By Brian T. Horowitz • July 27, 2023 -
Joe Raedle via Getty Images
Cleveland sues major PBMs, drug manufacturers over rising insulin prices
The suit argues that PBMs, including CVS Caremark, Express Scripts and OptumRx, use their market power to drive up the cost of insulin for Cleveland residents — approximately 17% of whom are diabetic.
By Sydney Halleman • July 26, 2023 -
Win McNamee via Getty Images
Biden administration cracks down on payers over mental health coverage
A new proposed rule from the HHS and Treasury and Labor departments would require health insurers to analyze patient outcomes to ensure their benefits are administered equally.
By Rebecca Pifer • July 25, 2023 -
Julia Rendleman via Getty Images
Cigna sued over algorithm allegedly used to deny claims
The lawsuit filed in a California district court argues the health insurer used the technology to “deny payment in batches of hundreds or thousands at a time,” violating state law.
By Rebecca Pifer • July 25, 2023 -
Courtesy of ChenMed
ChenMed taps UnitedHealthcare veteran as new president
Family members at value-based medical group ChenMed are stepping down from leadership roles.
By Rebecca Pifer • July 24, 2023 -
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PE ownership worsens quality, raises costs, according to BMJ review
The analysis comes as private equity investments in healthcare soar and regulators look to crack down on roll-up acquisitions.
By Sydney Halleman • July 24, 2023 -
Carol Highsmith. (2005). "The Apex Building" [Photo]. Retrieved from Wikimedia Commons.
Deep DiveNew antitrust merger guidelines could have significant chilling effect on healthcare deals
Regulators have historically struggled to make a case against complex and non-traditional tie-ups. That could change with the new guidelines.
By Rebecca Pifer • July 21, 2023 -
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Prior authorization denials could limit access in Medicaid managed care, OIG reports
Medicaid managed care organizations denied one out of every eight requests for prior authorization in 2019, and most states don’t regularly monitor if denials are appropriate, the HHS’ Office of the Inspector General found.
By Emily Olsen • July 20, 2023
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