Payer: Page 3
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Mario Tama via Getty Images
Labor union health fund targets hospital prices, looks to form purchasing coalition
If successful, the coalition would bring together New York City's largest public employee union and the United Federation of Teachers. Together the group would represent about 540,000 people.
By Samantha Liss • March 22, 2022 -
Rebecca Pifer/Healthcare Dive
HIMSS22Payer-to-payer data exchange rule to be published 'soon,' CMS head says at #HIMSS22
CMS hasn't been enforcing stipulations that payers share patient data with competitors set out in regulations finalized two years ago. But that could change soon with a new rule.
By Rebecca Pifer • March 15, 2022 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/Provider relationships
As M&A intensifies and companies are more likely to embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Permission granted by Biogen
Biogen and its partner rework terms of Aduhelm deal amid slow sales
Instead of sharing global profits and losses, Eisai will receive royalties tied to net sales of the Alzheimer's drug. Biogen, meanwhile, said the amended deal should make it easier to "address market developments."
By Jacob Bell • March 15, 2022 -
Dollar Photo Club
Sutter Health defeats antitrust challenge in jury trial
The federal jury in a class action suit rejected allegations that the California hospital system drove up healthcare costs in its markets through anti-competitive practices.
By Susan Kelly • March 14, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
Grassley pushes for PBM probe
The senator wants FTC commissioners to come up with a more targeted focus for the study and suggested narrowing a review to the impact on consumers and their out-of-pocket costs.
By Samantha Liss • March 14, 2022 -
Anthem plans to change name to Elevance
It's the second name change for Anthem in the past decade. Prior to 2014, the company was known as WellPoint.
By Shannon Muchmore • March 10, 2022 -
Medical groups say prior authorization burdens persisted during pandemic
A new survey of doctor practices from the Medical Group Management Association found 98% of respondents wrestled with an increased or steady level of prior authorization requirements over the past year.
By Susan Kelly • March 8, 2022 -
Fotolia
L.A. Care fined $55M after members faced barriers to timely care
The fine is reportedly the largest in California history following an investigation that revealed serious systemic failures.
By Samantha Liss • March 7, 2022 -
Samara Heisz via Getty Images
Civica targets insulin in effort to produce cheaper drugs
The nonprofit group announced ambitious plans to begin offering insulin at prices no higher than $30 per vial by early 2024.
By Kristin Jensen • March 4, 2022 -
Geisinger
Humana adds Cerner's Feinberg to board amid activist pressure
Longtime Humana board member Marissa Peterson will not stand for reelection at the upcoming shareholder meeting, according to a proxy statement.
By Samantha Liss • Updated March 9, 2022 -
Primary care physician turnover costs payers almost $1B every year, study finds
Disruptions in care continuity when primary care providers leave their practices was a costly issue even before the pandemic, according to the American Medical Association.
By Hailey Mensik • March 3, 2022 -
Win McNamee / Staff via Getty Images
Biden discusses drug prices, mental health services in annual address
The president also announced a "test to treat" program that would allow people to receive a COVID-19 test at a pharmacy and immediately receive free antiviral pills, such as Pfizer's Paxlovid or Merck's molnupiravir.
By Shannon Muchmore • March 2, 2022 -
Alex Wong via Getty Images
CMS redesigns controversial Medicare direct contracting model
The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders.
By Rebecca Pifer • Feb. 28, 2022 -
DOJ moves forward with suit to block UnitedHealth's acquisition of Change
The lawsuit alleges that if UnitedHealth acquired Change, the payer would be able to gain a competitive advantage by seeing "very competitively sensitive" data from other insurers.
By Shannon Muchmore • Feb. 25, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC seeks public comments on pharmacy benefit managers' impact on patients, pharmacies
After a failed bid to launch a formal inquiry into PBMs, the FTC now says it wants to collect comments from the public to study a wide array of PBM practices.
By Samantha Liss • Feb. 25, 2022 -
Courtesy of One Medical
One Medical partnering with Connecticut health system, but stock drags on high MLR
CEO Amir Dan Rubin told analysts in a call Wednesday that COVID-19 headwinds continue, including staffing shortages, a lag in return to care and reduced revenue from testing.
By Shannon Muchmore • Feb. 24, 2022 -
Courtesy of Humana
Humana agrees to board refresh in deal with activist hedge fund
It's the latest insurer facing pressure from an activist investor group, following a shakeup at Centene.
By Samantha Liss • Feb. 23, 2022 -
Ground ambulance costs continue to soar, study finds
More ambulance trips are billing for "advanced life support," denoting a higher level of care (and reimbursement). Private insurers' payments for those trips increased 56% between 2017 and 2020, Fair Health found.
By Rebecca Pifer • Feb. 22, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC to vote on investigation into PBMs' drug pricing practices
The agency's commissioners will weigh Thursday whether to investigate PBMs and their relationship to drug prices and "practices that may disadvantage independent or specialty pharmacies," according to the meeting agenda.
By Samantha Liss • Feb. 17, 2022 -
Retrieved from FTC.
FTC fails to get enough votes to launch study into PBM practices
Numerous pharmacists urged commissioners to probe the practices of PBMs, which they allege harm their independent pharmacies and threaten to drive them out of business.
By Samantha Liss • Feb. 17, 2022 -
Molina plans steep reduction in marketplace enrollment
The payer is expected to lose two-thirds of its marketplace enrollment by the end of the year, according to executives.
By Samantha Liss • Feb. 16, 2022 -
UnitedHealth Group
DOJ has until Feb. 27 to sue to block UnitedHealth's $8B Change acquisition
The companies said they would give the DOJ 10 days notice before completing the merger, during which the DOJ could launch a lawsuit to block it. On Feb. 17, UnitedHealth and Change gave the regulators that notice.
By Rebecca Pifer • Updated Feb. 22, 2022 -
CMS
Smaller rivals snap up Medicare Advantage members
MA startups were able to win market share during the most recent open enrollment period, threatening the market share of incumbents and suggesting more willingness to shop among U.S. seniors.
By Samantha Liss • Feb. 9, 2022 -
Bruce Bennett via Getty Images
Boosters and test demand — coupled with lower COVID-19 treatment costs — drove CVS profit up 33% in Q4
People flocked to get booster shots as the omicron variant drove a sharp increase in testing, boosting revenue for CVS' drugstore segment. Meanwhile, its payer arm reported lower-than-expected COVID-19 treatment costs.
By Rebecca Pifer • Feb. 9, 2022 -
Jury trial gets underway in antitrust suit against Sutter Health
The California hospital system is accused of wielding its market power to drive up health insurance premiums for hundreds of thousands of consumers.
By Susan Kelly • Feb. 9, 2022
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