Payer: Page 3

Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up

"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.

By Samantha Liss • Aug. 06, 2020

CVS profit soars to $3B on lower medical utilization

The performance of CVS' health benefits arm, which includes major commercial payer Aetna, more than offset a sharp earnings drop in its retail segment as COVID-19 slashed foot traffic to its brick-and-mortar locations.

By Rebecca Pifer • Aug. 05, 2020

Explore the Trendline➔

Trendline

Social determinants of health

The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.

By Healthcare Dive staff

iRhythm stock leaps 33% after CMS pitches new reimbursement codes

Permanent codes validate the digital health company's wearable heart monitoring technology and could drive more widespread adoption for detection of atrial fibrillation and other abnormal rhythms, CEO Kevin King said.

By Susan Kelly • Aug. 05, 2020

Humana joins peers in reporting depressed usage, larger income in Q2

The payer increased its outlook for earnings and individual Medicare Advantage membership as it saw revenue jump about 17% in the quarter.

By Samantha Liss • Aug. 05, 2020

CMS expands telehealth coverage in physician fee rule following Trump executive order

The agency is proposing making permanent almost two dozen new telehealth codes. A notable exception is Medicare's temporary reimbursement for audio-only visits, though the agency did ask for public input on the omission.

By Rebecca Pifer • Aug. 04, 2020

Oscar expands into 4 new states, touts new virtual primary care option

Flush off raising $225 million in late-stage funding last month and a new initiative with Cigna to sell coverage to small businesses, the startup is looking to grow.

By Ron Shinkman • July 31, 2020

Molina Q2 profit surges 40% as provider volumes wane

The MCO joined other insurers in posting big profit gains, though it has yet to revise its full-year earnings forecast amid continued COVID-19 uncertainty.

By Samantha Liss • July 31, 2020

Medicaid managed care rates on state chopping blocks, with Centene and Molina at risk

Centene execs this week declined to quantify how reductions by states facing shortfalls may impact financial performance or guidance, while Molina provided a direct estimate on Friday.

By Samantha Liss • July 31, 2020

Cigna beats in Q2 as commercial enrollment nearly steady despite pandemic

The payer posted profit of $1.75 billion, up nearly 25% year over year. Like other insurers, the company saw increased profit as people deferred care in April and May to forgo potential exposure to the novel coronavirus.

By Shannon Muchmore • July 30, 2020

HHS prods Congress to act on surprise billing, but doesn't take a side on how

Congress has taken some action on surprise billing in the face of the coronavirus pandemic, barring the practice for COVID-19 testing and treatment during the public health emergency. Still, a larger overhaul is unlikely soon.

By Shannon Muchmore • July 29, 2020

Anthem posts $2.3B profit in Q2 as Medicaid growth outpaces commercial losses

Like for other payers, the COVID-19 pandemic has tamped down healthcare use and resulting costs. Executives said utilization among members was down about 40% in April and 20% in May but returned nearly to baseline last month.

By Shannon Muchmore • July 29, 2020

Telehealth made up almost half of all Medicare beneficiaries' primary care use in April

Fee-for-service beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report.

By Rebecca Pifer • July 29, 2020

Humana invests $100M in at-home primary care startup Heal

"The fact that healthcare belongs in the home — there's an exclamation mark to it, because of the pandemic, but we believed it before," Heal CEO Nick Desai told Healthcare Dive.

By Rebecca Pifer • July 29, 2020

Centene more than doubles Q2 profit amid pandemic

The results were aided by the COVID-19 crisis as medical use fell due to stay-at-home orders and patients delaying care, though the payer had slower enrollment gains as employers furlough workers instead of terminating them.

By Samantha Liss • July 28, 2020

CMS to begin recouping COVID-19 Medicare loans

Hospital groups have pleaded with the Trump administration and Congress to forgive the loans, or relax repayment terms, with no relief so far.

By Rebecca Pifer • July 27, 2020

6 months in: The COVID-19 crisis

This series of stories examines how healthcare has changed during the course of the novel coronavirus in the United States, half a year after HHS declared a national public health emergency.

Skinny short-term plans deny coverage for pre-existing conditions: Commonwealth Fund

The analysis of more than 400 plans called junk by critics concluded few offer tangible benefits. The Trump administration backs short-term plans, arguing they're a low-cost alternative to broader coverage.

By Ron Shinkman • July 23, 2020

Opinion

Why COVID-19's biggest impact on healthcare may not be until 2022

This perfect storm of a shift in payer mix, the impending insolvency of Medicare and the inability of states to absorb the growing costs of Medicaid represent a tsunami of challenges, former VA Secretary David Shulkin writes.

By David Shulkin • July 23, 2020

M&A volume in health services for H1 was lowest since 2015, PwC finds

The subsector with the most deals in terms of volume was long-term care, continuing a trend since 2014, followed by other services, physician medical groups, hospitals and home health, according to the analysis.

By Shannon Muchmore • July 23, 2020

Coronavirus vaccine developers make case to Congress they can win public's trust

While developing a safe and effective vaccine remains the chief challenge, lawmakers grilled pharma officials on how any successful shot would be fairly priced and distributed.

By Ben Fidler • July 22, 2020

UnitedHealthcare gets lowest grades in Leapfrog poll, average plan gets C+

The biggest commercial payer got the lowest satisfaction ratings on moving toward cost and quality and also the lowest GPA, the new survey of more than 170 employers found.

By Rebecca Pifer • July 22, 2020

Direct primary care backers hope COVID-19 entices docs to alternate payment model

Some practices using the model, where patients pay a flat fee with no insurance accepted, say their finances have been relatively unchanged since the start of the pandemic.

By Rebecca Pifer • July 21, 2020

Molina acquires Kentucky's second-largest Medicaid plan for $20M

The payer closed the deal this week and now covers about 315,000 more Medicaid members in the state.

By Samantha Liss • UPDATED: Sept. 1, 2020 at 3:04 p.m.

Appeals court upholds Trump admin's expansion of short-term health plans

The Association of Community Affiliated Plans said it would appeal Friday's decision, slamming the bare-bones plans — which sparked a yearlong Democrat committee investigation — as "junk insurance."

By Rebecca Pifer • July 17, 2020

Express Scripts faces lawsuit alleging it overcharged Ohio public pension fund

"We want our money back," AG Dave Yost said in a statement, contending the PBM "egregiously charged for services it didn't deliver." It's the latest action by the state cracking down on pharmacy benefit managers.

By Samantha Liss • July 15, 2020