Payer: Page 30
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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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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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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 -
Samantha Liss/Healthcare Dive
Centene wins New Hampshire Medicaid contract
It’s not yet clear how much the new Medicaid managed care contract is worth. The state’s previous contract with insurers, including Centene, allocated $6 billion in funds over five years.
By Rebecca Pifer Parduhn • Jan. 19, 2024 -
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Bright Health rebrands as NeueHealth, distances itself from insurance portfolio
After exiting the insurance business, the tech company will focus on providing care support and solutions for consumers and providers.
By Susanna Vogel • Jan. 18, 2024 -
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Humana slashes 2023 profit outlook as high medical costs continue
The insurer also lowered its expectations for Medicare Advantage membership growth this year to below the industry average.
By Rebecca Pifer Parduhn • Jan. 18, 2024 -
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Top healthcare trends in 2024
Here’s what industry experts see coming down the pike for hospitals, insurers and digital health companies this year.
By Healthcare Dive Staff • Jan. 18, 2024 -
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Cigna CFO takes on expanded role as head of benefits division
Brian Evanko will serve as president and CEO of the Cigna Healthcare insurance division in addition to his position as chief financial officer.
By Emily Olsen • Jan. 17, 2024 -
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Rising health insurance premiums linked to wage stagnation, study finds
Families with employer-sponsored plans missed out on an average of more than $125,000 in earnings over more than three decades as premiums increased, according to a study published in JAMA Network Open.
By Emily Olsen • Jan. 17, 2024 -
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CMS finalizes rule tightening prior authorization turnaround for insurers
Payers have new deadlines to issue prior authorization decisions — 72 hours for urgent requests and seven days for non-urgent ones — that should cut back coverage determination limbo for patients.
By Rebecca Pifer Parduhn • Jan. 17, 2024 -
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MA spending to outstrip traditional Medicare by $88B this year: MedPAC
MedPAC released the data Friday during a contentious meeting where members argued over the efficacy of Medicare Advantage.
By Rebecca Pifer Parduhn • Jan. 16, 2024 -
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Deep DiveTrends shaping the business of health insurance in 2024
The uninsured rate will rise. Medicare Advantage enrollment will swell, with less instability. Major pharmacy benefit managers will launch more transparent products. Here’s what industry watchers are expecting in 2024.
By Rebecca Pifer Parduhn • Jan. 16, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth reports highest medical costs since COVID-19 pandemic’s start
While the insurer continues to be rocked by more seniors seeking outpatient care, the fourth quarter also saw high levels of vaccinations and COVID-19 admissions that accelerated spending.
By Rebecca Pifer Parduhn • Jan. 12, 2024 -
Adeline Kon/Healthcare Dive/Healthcare Dive
ACA enrollment for 2024 reaches record high
More than 20 million Americans have signed up for Affordable Care Act plans since open enrollment began in November. Sign-ups are expected to continue to grow.
By Rebecca Pifer Parduhn • Jan. 11, 2024 -
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Kentucky-based Baptist Health drops UnitedHealthcare, Centene MA plans
Kentucky-based Baptist Health has gone out of network with UnitedHealthcare and Centene’s WellCare Medicare Advantage plans after failing to agree to contract terms.
By Sydney Halleman • Jan. 10, 2024 -
Courtesy of Walgreens
Walgreens to pay Humana $360M to settle drug pricing dispute
The settlement is a little over half of what Walgreens was originally ordered to pay, after an arbiter said the retail pharmacy chain overcharged Humana for prescription drugs for more than a decade.
By Rebecca Pifer Parduhn • Jan. 9, 2024 -
Permission granted by Elevance Health
Elevance sues HHS over Medicare Advantage star ratings
The payer is taking issue with how regulators calculated quality scores for 2024, after seeing a stars decline that could cause its bonus revenue to fall by $500 million.
By Rebecca Pifer Parduhn • Jan. 8, 2024 -
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More hospitals, payers compliant with price transparency laws
More than 90% of hospitals posted files at least partially compliant with price transparency requirements in 2023, according to a new report from Turquoise Health.
By Susanna Vogel • Jan. 5, 2024 -
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CVS names Tom Cowhey permanent CFO
The company on Friday solidified what had been a temporary role for Cowhey, while sharing it expects enrollment in Medicare Advantage plans to exceed previous targets for 2024.
By Rebecca Pifer Parduhn • Jan. 5, 2024 -
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Cigna, HCSC near deal on Medicare Advantage business: WSJ
The news comes less than a month after Cigna and Humana reportedly abandoned their merger.
By Susanna Vogel • Jan. 4, 2024 -
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Blue Shield of California says it will lay off 140
A spokesperson attributed the cuts to economic headwinds and a need to reduce administrative costs.
By Susanna Vogel • Jan. 3, 2024
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