MA enrollment in rural areas nearly quadrupled since 2010, KFF finds

More rural seniors are turning to Medicare Advantage, but the plans can offer limited provider networks. That could prove an additional challenge for rural beneficiaries who already have to travel further distances for care.

By Emily Olsen • Sept. 8, 2023

CVS shuffles C-suite, appoints CFO as head of health services

Shawn Guertin will now helm the healthcare giant's suite of care delivery businesses, including Oak Street and Signify, as CVS undergoes a major corporate restructuring following flagging profits.

By Rebecca Pifer Parduhn • Sept. 8, 2023

Astellas withdraws lawsuit challenging Medicare drug price program

Contrary to the drugmaker’s expectations, its top-selling cancer medicine Xtandi wasn’t picked as one of the first 10 drugs to face price negotiations.

By Ned Pagliarulo • Sept. 7, 2023

MA plans were overpaid $9.3B annually from 2017 to 2020, study finds

Favorable selection of healthier beneficiaries led to overpayments in counties with high Medicare Advantage penetration, but benchmark changes could mitigate the impact.

By Emily Olsen • Sept. 6, 2023

CMS creates all-payer funding opportunity for states

Regulators' latest effort to nudge the U.S. away from fee-for-service takes a page from how Maryland pays its hospitals.

By Rebecca Pifer Parduhn • Sept. 6, 2023

Patients ‘steered’ toward health systems, more costly treatment after vertical consolidation, study finds

Consolidation between primary care physicians and large health systems led to increased costs per patient, according to a new study published in JAMA.

By Susanna Vogel • Sept. 5, 2023

Humana sues HHS over Medicare Advantage audits

The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.

By Rebecca Pifer Parduhn • Sept. 5, 2023

‘We’re in the 1999 of the internet era’: a16z’s Julie Yoo on fintech’s potential and the digital health market

Yoo, who leads health tech investment at venture capital firm Andreessen Horowitz, outlined her fintech investment thesis and why the healthcare industry is at an inflection point for adoption.

By Rebecca Pifer Parduhn • Aug. 31, 2023

Prisma Health files suit against UnitedHealthcare, alleging ‘bad faith’ contract negotiation tactics

The South Carolina-based health system alleges that the insurer broke its contract and gave "false and misleading" statements to the press about Prisma’s proposed rates for 2024.

By Susanna Vogel • Aug. 31, 2023

Medicaid cracks down on states over children wrongly losing coverage during redeterminations

The Biden administration is threatening state Medicaid agencies with sanctions after finding an automation glitch that could cause eligible children to lose coverage.

By Rebecca Pifer Parduhn • Aug. 31, 2023

Employers should focus on provider quality to cut low-value care in plans, report finds

In the employer-sponsored insurer market, employers play a “critical” role when it comes to quality and outcomes, according to a report by Morgan Health and Embold Health.

By Emily Olsen • Aug. 30, 2023

Humana launches in-home senior care program through CenterWell in Georgia, Louisiana

The program builds on Humana’s acquisition of home-based primary care provider Heal earlier this year, and could expand to 10 additional southern and southwestern states.

By Rebecca Pifer Parduhn • Updated Aug. 30, 2023

Bon Secours sues Anthem BCBS over unpaid claims

The Cincinnati-based health system is alleging the Elevance subsidiary owes $93 million following four years of contract disputes.

By Rebecca Pifer Parduhn • Aug. 29, 2023

Cigna to exit Missouri and Kansas ACA marketplaces in 2024

The insurer will offer ACA marketplace plans in two fewer states after announcing it would expand its presence on the exchanges last year. 

By Emily Olsen • Aug. 28, 2023

Texas judge rules to vacate more No Surprises Act regulations

The ruling, which targets guidance related to the independent dispute resolution process, prompted the CMS to again pause all federal disputes.

By Sydney Halleman • Aug. 28, 2023

Shared Savings ACOs saved Medicare $1.8B in 2022

Nearly two-thirds of participating accountable care organizations earned payments for their performance last year, according to the CMS.

By Emily Olsen • Aug. 25, 2023

CVS launches new venture in biosimilar drug experiment

The subsidiary, called Cordavis, will work directly with manufacturers to market or co-produce low-cost biologic drugs, starting with Novartis’ Humira copy.

By Jonathan Gardner • Aug. 24, 2023

Cigna removes prior authorizations for 25% of services

The insurer also plans to nix another 500 codes for its Medicare Advantage plans before the end of this year.

By Rebecca Pifer Parduhn • Aug. 24, 2023

Large employers predict pharmacy spend, mental health needs will continue to rise

“The road ahead for prescription drug and pharmacy looks quite daunting,” said the CEO of the Business Group on Health following a recent survey.

By Rebecca Pifer Parduhn • Aug. 23, 2023

MA beneficiaries like their plans, but few say it’s easy to find care

Trust and the ability to resolve problems or complaints were factors most highly correlated with members’ likelihood of renewing their plans, according to a new J.D. Power study.

By Emily Olsen • Aug. 23, 2023

Florida sued over Medicaid redeterminations

Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicaid coverage without proper notice.

By Rebecca Pifer Parduhn • Aug. 23, 2023

CVS layoffs hit Rhode Island, Connecticut, New York and more

The layoffs disclosed late last week to state labor departments include 770 employees in CVS’ Rhode Island headquarters, and about 520 workers at health insurer Aetna’s Connecticut hub.

By Rebecca Pifer Parduhn • Aug. 21, 2023

Ground ambulance billing committee skeptical of IDR process

A key congressional advisory group met last week to deliberate preventing unexpected bills after medical transport, but said the status quo dispute resolution process isn’t the solution.

By Rebecca Pifer Parduhn • Aug. 17, 2023

Blue Shield of California drops CVS Caremark in pharmacy benefit overhaul

BSCA has kicked CVS Caremark, the largest pharmacy benefit manager in the country, to the curb and is electing to carve out various pharmacy functions with companies like Amazon instead.

By Rebecca Pifer Parduhn • Updated Aug. 17, 2023

Kroger, Intermountain subsidiary Select Health launch co-branded MA plan

It's the grocery chain's third MA plan in partnership with a health insurer. Kroger also operates plans with Elevance and Priority Health.

By Rebecca Pifer Parduhn • Aug. 16, 2023