Payer: Page 3
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Humana sued over alleged 340B underpayments in Medicare Advantage
Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.
By Emily Olsen • Feb. 13, 2024 -
Permission granted by Elevance Health
Elevance lays off more employees
The health insurer has quietly laid off thousands of employees since September, according to sources.
By Rebecca Pifer • Feb. 13, 2024 -
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TrendlineSocial 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 -
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FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance
The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.
By Rebecca Pifer • Feb. 12, 2024 -
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Molina’s redeterminations losses reach 500K members
As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.
By Rebecca Pifer • Feb. 8, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth COO Dirk McMahon to retire
McMahon is leaving after two decades at the insurer.
By Rebecca Pifer • Feb. 8, 2024 -
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CVS cuts 2024 outlook on Medicare Advantage caution
The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.
By Rebecca Pifer • Feb. 7, 2024 -
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AHA calls for more payer oversight in No Surprises dispute resolution
In comments on a proposed rule, the American Hospital Association argued regulators haven’t fully addressed how they’ll handle oversight for some situations, like when an insurer fails to pay after a dispute determination.
By Emily Olsen • Feb. 7, 2024 -
Samantha Liss/Healthcare Dive
Centene echoes Humana’s concerns about proposed MA rate drop
On the insurer’s earnings call, analysts peppered Centene with questions about its Medicare Advantage business until its CFO attempted to change the subject.
By Rebecca Pifer • Feb. 6, 2024 -
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Q&ABeMe’s CEO Nicki Tessler on digital behavioral health programs and payer partnerships
Depression and anxiety climbed among teens during the COVID-19 pandemic. Nicki Tessler, CEO and cofounder of BeMe Health, breaks down solutions.
By Brian T. Horowitz • Feb. 5, 2024 -
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Humana flags potential MA funding dip if proposed rate notice finalized
Despite the uncertainty, the insurer reaffirmed its earnings outlook for 2025.
By Rebecca Pifer • Feb. 5, 2024 -
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Cigna is still interested in Medicare
The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.
By Rebecca Pifer • Feb. 2, 2024 -
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Medicare Advantage plans could see rates dip slightly in 2025
The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.
By Rebecca Pifer • Feb. 1, 2024 -
Courtesy of Humana
Humana plots CenterWell expansion in 2024
The payer is leveraging CenterWell’s growing network of primary care centers for seniors to boost margins in its hard-pressed Medicare Advantage business.
By Rebecca Pifer • Jan. 31, 2024 -
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Cigna sells Medicare businesses to HCSC for $3.7B
The transaction exits Cigna from a sector that’s been a huge source of growth for insurers but has seen its earnings potential shrink.
By Rebecca Pifer • Jan. 31, 2024 -
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Medicare Advantage profitability is declining, Moody’s says
Insurers' MA earnings were 2% lower in 2022 than in 2019, signaling profits in the lucrative insurance program may be weakening.
By Emily Olsen • Jan. 30, 2024 -
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Medicare ACO participation grows in 2024: CMS
However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.
By Rebecca Pifer • Jan. 30, 2024 -
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No Surprises Act prevented 10M surprise bills in first nine months of 2023, insurer groups say
AHIP and BCBSA also took aim at providers for allegedly abusing the billing dispute resolution process set up by No Surprises, in the latest salvo over the polarizing law.
By Rebecca Pifer • Jan. 29, 2024 -
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Humana names inaugural ‘Growth President’ after posting grim financial outlook
David Dintenfass will have his hands full trying to right the ship, as Humana stares down expectations for notably slower growth in 2024 and beyond.
By Rebecca Pifer • Jan. 26, 2024 -
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Appeals court rejects doctors’ challenge to No Surprises Act
A three-judge panel of the Second Circuit Appeals Court has dismissed claims from a New York medical group that the law amounts to an unconstitutional seizure of their property.
By Rebecca Pifer • Jan. 25, 2024 -
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Humana posts big loss, dour outlook on Medicare Advantage cost spike
The health insurer’s stock plunged Thursday morning following its 2023 results, which fell startlingly short of Wall Street’s expectations.
By Rebecca Pifer • Jan. 24, 2024 -
Permission granted by Elevance Health
Elevance controls medical costs to $6B profit in 2023
The payer curbed the worst of medical cost growth last year, and expects to do the same in 2024 — an assumption one analyst called “aggressive” given persistent higher utilization among seniors.
By Rebecca Pifer • Jan. 24, 2024 -
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Senator probes MA exchanges’ marketing tactics
The head of the Senate Finance Committee sent letters to several health insurance exchanges on Tuesday, as part of an inquiry into allegedly predatory Medicare Advantage marketing to seniors.
By Sydney Halleman • Jan. 24, 2024 -
Samantha Liss/Healthcare Dive
Centene names Wellcare CEO
Michael Carson, a veteran of the insurance and value-based care industry, has been tapped to lead Centene’s Medicare business.
By Rebecca Pifer • Jan. 22, 2024 -
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Sponsored by TeleperformanceImplementing high-tech, high-touch digital services to create more personalized, patient-centric care
Improve the patient experience by addressing high interaction volume and channel complexity.
By Jeff Hechemy, Executive Vice President – Healthcare at Teleperformance • Jan. 22, 2024 -
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Sponsored by PegasystemsAdaptive AI: Driving value beyond the hype
Generative AI gets the attention, but adaptive AI drives the value.
By Robert Connely, Global Market Leader for Healthcare, Pegasystems • Jan. 22, 2024
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