MA beneficiaries with chronic conditions have lower utilization, spending, industry-backed report finds

The Better Medicare Alliance-funded analysis compared beneficiaries with hypertension, hyperlipidemia and diabetes across MA and traditional Medicare and found that spending was “consistently higher” among FFS beneficiaries.

By Emily Olsen • June 28, 2023

Pfizer, citing safety concerns, scraps one of two obesity pill hopefuls

Liver enzyme elevations in early- and mid-stage testing have led the drugmaker to discontinue development of a medicine known as lotiglipron, dealing a blow to its hopes of catching rivals Lilly and Novo Nordisk. 

By Ben Fidler • June 26, 2023

Explore the Trendline➔

Payer/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

North Carolina places Friday Health Plans into receivership as insurtech shuts down

A number of states have already moved to take control of the insurer, which announced it was winding down operations earlier this month.

By Emily Olsen • June 22, 2023

State Medicaid spending fell below pre-pandemic levels during continuous enrollment

An analysis by KFF found state spending on Medicaid fell during the COVID-19 pandemic even as enrollment soared. But spending will likely increase as the federal government begins to pare back its increased contribution.

By Emily Olsen • June 21, 2023

Insured adults give their health plans positive ratings, but most report problems

KFF found 81% of those surveyed gave their health plans an overall rating of “excellent” or “good.” But more than half also reported insurance problems like denied claims or network issues in the past year.

By Emily Olsen • June 20, 2023

Humana becomes second major payer to flag higher outpatient volumes in Q2

Pent-up demand for healthcare delayed during COVID-19 is making a reappearance, pressuring medical costs for health insurers that had a financial windfall during the pandemic.

By Rebecca Pifer • June 16, 2023

MedPAC recommends return to lower telehealth payments

The group that advises Congress on Medicare policy also suggested more closely setting payment rates across outpatient facilities for some services, which hospital lobbyists oppose.

By Emily Olsen • June 16, 2023

Large, geographically diverse insurers see ‘very stable’ operating performance

Payers including UnitedHealth, Elevance Health, Cigna and Humana are benefiting from strong market share that aids them in negotiations with providers, Fitch Ratings found.

By Emily Olsen • June 14, 2023

UnitedHealth expects higher medical costs in Q2 as delayed care makes comeback

The insurer expects its medical loss ratio in the second quarter to reach or exceed its full-year target. UnitedHealth’s stock, along with that of other major Medicare payers, fell in Wednesday morning trading as a result.

By Rebecca Pifer • June 14, 2023

Medicare Advantage overpayments could exceed $75B this year, study finds

The figure is almost triple prior estimates, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.

By Emily Olsen • June 14, 2023

Expanded federal safety net during COVID led to improved health access for adults, report finds

Between 2019 and 2022, fewer adults reported taking on medical debt or forgoing medical care due to cost, according to the Robert Wood Johnson Foundation.

By Susanna Vogel • June 13, 2023

HHS offers aid amid Medicaid redetermination coverage losses

Secretary Xavier Becerra urged states to adopt new flexibilities to limit Medicaid churn, adding in a letter to state governors that he's "deeply concerned" about unnecessary coverage losses.

By Emily Olsen • June 13, 2023

Uber Health adds grocery, over-the-counter item delivery

The rideshare provider, which already offers non-emergency medical transportation and prescription delivery, has been expanding beyond medical transportation to coordinate care across multiple benefits.

By Rebecca Pifer • June 13, 2023

CMS exploring models centered on social health factors

Regulators said they’re trying to work around restrictions regarding what groups Medicare is allowed to pay as they look to address social determinants of health.

By Rebecca Pifer • June 9, 2023

Insurers report stable performance amid industry headwinds, but cost pressures loom

Provider cost pressures are weighing on the nation's largest insurers, with contract negotiations possibly forcing premiums higher over the next few years, according to Fitch Ratings.

By Sydney Halleman • June 7, 2023

Merck sues to stop Medicare negotiation of drug prices

The drugmaker’s lawsuit claims the new pricing powers granted by the Inflation Reduction Act are unconstitutional and “tantamount to extortion.”

By Christopher Newman • June 6, 2023

Friday Health Plans to shut down as state regulators step in

In a statement, the insurer said it was “unable to scale our financial infrastructure to match the pace of our growth and secure the additional capital required to run our business.”

By Emily Olsen • June 5, 2023

UnitedHealth rolls back gastroenterology prior authorization plan amid backlash

The American Hospital Association said it thinks the new advance notification process is a better approach than prior authorization, but other medical groups took a harsher stance against the refocused policy.

By Rebecca Pifer • June 2, 2023

Over half a million disenrolled amid Medicaid redeterminations so far

A KFF analysis of 11 states found many of the people who have already been removed from the Medicaid program were disenrolled for procedural reasons.

By Emily Olsen • June 1, 2023

Medicare keeps limits on Alzheimer’s drug coverage, but loosens policy

The agency will reimburse Alzheimer’s treatments if they receive full FDA approval, but plans to still require data collection via a patient registry.

By Christopher Newman • June 1, 2023

Healthcare costs top $31,000 for family of 4 in 2023

After declining briefly in 2020, family healthcare costs are rising as the industry faces an uncertain macroeconomic environment.

By Emily Olsen • June 1, 2023

Members’ satisfaction with commercial health plans declines

A J.D. Power study found overall satisfaction with commercial health plans fell, with sicker members less likely to receive outreach and care coordination.

By Emily Olsen • May 31, 2023

Kaiser pledges $10M to safety-net hospital to stem ‘unprecedented financial challenges’

Denver Health — the largest provider of care for uninsured people in the city — has struggled with rising costs and a surge in sicker patients.

By Sydney Halleman • May 31, 2023

Postpartum people could lose coverage amid Medicaid redeterminations

People in some states could lose postpartum coverage 60 days after giving birth, even though health risks from pregnancy can continue for months, according to a new report from KFF.

By Emily Olsen • May 30, 2023

Healthcare provisions of the debt limit deal: COVID-19 funding clawbacks, no Medicaid work requirements

Congressional Republicans and the White House reached a deal over the weekend to raise the debt ceiling that includes healthcare policy wins for both sides of the aisle.

By Rebecca Pifer • May 30, 2023