Insurance coverage not a panacea for healthcare affordability: survey

Numerous studies have outlined how high medical costs affect uninsured individuals, but healthcare prices are straining household budgets regardless of insurance type, according to the Commonwealth Fund.

By Rebecca Pifer Parduhn • Oct. 26, 2023

Defunct direct contracting model saved Medicare $372M last year

Value-based primary care chains for seniors operated by major retail health players did particularly well, with Amazon’s Iora, CVS’ Oak Street and Walgreens’ VillageMD all notching high net savings.

By Rebecca Pifer Parduhn • Oct. 25, 2023

Blue Shield of California is promising a simpler, cheaper pharmacy benefits model. Can it deliver?

Big questions hang over the California health insurer's bold experiment — having five vendors carry out PBM functions previously performed by one — that could threaten BSCA's expected savings.

By Rebecca Pifer Parduhn • Updated Oct. 26, 2023

Centene beats Q3 forecasts despite stars, redeterminations pressures

The payer’s Medicare Advantage star ratings have improved slightly, but “certainly do not reflect the ambitions of our company,” CEO Sarah London said.

By Rebecca Pifer Parduhn • Oct. 24, 2023

2.3M people would gain coverage if 10 remaining states expanded Medicaid, report finds

Black people, young adults and women, especially those of reproductive age, would see the biggest coverage gains, according to the Robert Wood Johnson Foundation and the Urban Institute.

By Emily Olsen • Oct. 24, 2023

Blue Cross NC closes purchase of FastMed urgent care clinics

The insurer also named Jim Moffett, who previously worked at a Florida-based division of Trinity Health, as the urgent care chain’s CEO.

By Emily Olsen • Updated Jan. 18, 2024

Express Scripts sued by independent pharmacies over alleged price fixing

The Cigna-owned pharmacy benefit manager colluded with rival Prime Therapeutics to overcharge pharmacies, according to a lawsuit filed last week.

By Rebecca Pifer Parduhn • Oct. 23, 2023

Walgreens, Alignment partner on co-branded MA plans

The zero-dollar premium plans will be available in 10 counties in Arizona, California, Florida and Texas starting next year.

By Emily Olsen • Oct. 18, 2023

Premiums rose 7% for employer-sponsored health coverage in 2023

The average premium was nearly $8,500 for single coverage and nearly $24,000 for family coverage this year, according to a new study published in Health Affairs.

By Emily Olsen • Oct. 18, 2023

Elevance could see $500M quality bonus revenue hit in 2025 from MA star ratings drop

The insurer is actively seeking ways to mitigate the financial impact of its star ratings drop, Elevance CEO Gail Boudreaux said during the insurer’s third-quarter earnings call.

By Sydney Halleman • Oct. 18, 2023

CVS shuffles leadership again as CFO takes leave

The changes come about a month after the pharmacy giant appointed CFO Shawn Guertin as president of its health services segment.

By Emily Olsen • Oct. 16, 2023

Share of MA, Part D plans earning top star ratings drops in 2024

About 42% of Medicare Advantage plans that offer prescription drug coverage in 2024 earned four or more stars, compared with just over half this year. 

By Emily Olsen • Oct. 13, 2023

GLP-1s for weight loss leave employers in a bind over coverage

Employers face a difficult decision over whether to cover pricey weight loss drugs that pits the health and wellbeing of their employees against the health of their bottom line.

By Rebecca Pifer Parduhn • Oct. 13, 2023

UnitedHealth raises guidance, beats Q3 expectations on stabilizing MLR

The payer reported a lower medical cost ratio, but executives noted that costs could rise in the fourth quarter.

By Sydney Halleman • Oct. 13, 2023

AI, M&A and MSK: Teladoc’s head of group health shares vendor’s strategic priorities

Kelly Bliss discussed how the virtual care giant is approaching the three buzzy acronyms in an interview at HLTH.

By Rebecca Pifer Parduhn • Oct. 12, 2023

Elevance confirms ‘adjustments’ to resources as employees report job cuts

Elevance, formerly known as Anthem, employs nearly 100,000 people and serves more than 117 million customers, according to the company.

By Emily Olsen • Oct. 12, 2023

Humana CEO to step down next year

Jim Rechtin, president and CEO of physician staffing firm Envision Healthcare, will take the reins as chief executive of the payer in the latter half of 2024.

By Emily Olsen • Oct. 11, 2023

Cigna’s Evernorth acquires Bright.md’s asynchronous care tech

Evernorth’s telehealth business MDLive plans to start offering asynchronous care using the new capabilities within its virtual urgent care platform in 2024.

By Rebecca Pifer Parduhn • Oct. 10, 2023

Uber adds Optum-enabled benefits cards to health platform

The new deal has made Uber a “patient entry point” into the health benefits system, according to Uber Health global lead Caitlin Donovan.

By Rebecca Pifer Parduhn • Oct. 9, 2023

Aetna may have received $25.5M in MA overpayments for 2015 and 2016, audit finds

Medical records provided by the insurer didn’t support certain diagnosis codes, resulting in overpayments, according to an audit from the HHS Office of the Inspector General.

By Emily Olsen • Oct. 6, 2023

Top healthcare conferences in 2024

From digital health events to payer and provider summits, here are upcoming healthcare conferences for the organized executive to keep in mind.

By Sydney Halleman • Updated Dec. 4, 2023

Froedtert signs deal with Ascension Wisconsin to take full ownership of health plan

The Milwaukee-based health system plans to buy the remaining 50% stake in Network Health, which offers commercial and Medicare plans in 23 Wisconsin counties.

By Emily Olsen • Oct. 4, 2023

Warren, Jayapal call for closer scrutiny of UnitedHealth-Amedisys deal

The progressive lawmakers sent a letter to top antitrust regulators urging heightened attention to the $3.3 billion transaction, which is currently under investigation by the Department of Justice.

By Rebecca Pifer Parduhn • Oct. 4, 2023

Molina loses anticipated Indiana Medicaid contract

The health insurer expected to be offered a contract to manage the care of Medicaid seniors in a new long-term services and supports program, but wasn’t able to stand up a dual-eligible special needs plan in time.

By Rebecca Pifer Parduhn • Oct. 3, 2023

Anthem, Bon Secours reach contract agreement through 2028

The new contract puts to bed four years of tense network disputes between the Catholic health system and the Elevance subsidiary.

By Rebecca Pifer Parduhn • Oct. 2, 2023