Cigna addresses MA overhaul, fresh off $6.7B in profit

CEO David Cordani discussed the CMS’ recent changes to the Medicare Advantage program, Cigna’s multibillion-dollar investment in VillageMD and more in the payer’s fourth-quarter earnings call on Friday.

By Rebecca Pifer • Feb. 3, 2023

More patients — especially younger ones — are switching providers, survey finds

About 30% of patients selected a new provider in 2021, up from 26% in 2017, according to a new report from Accenture. Gen Zers and millennials were six times more likely to switch providers than older people.

By Hailey Mensik • Feb. 2, 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

CMS issues 2% MA rate hike for 2024

Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

By Shannon Muchmore • Feb. 2, 2023

Texas Medical Association files fourth suit challenging surprise billing ban

The latest lawsuit focuses on boosted fees that both parties must pay for arbitration to solve billing disputes between providers and payers.

By Hailey Mensik • Feb. 1, 2023

Humana expects 14% hike in 2023 MA enrollment as it taps new leaders

The payer said it expects to pick up 625,000 individual Medicare Advantage members in 2023.

By Samantha Liss • Feb. 1, 2023

CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers

Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments. 

By Samantha Liss • Jan. 31, 2023

Insurance lobby blasts Medicare Advantage audit rule

The America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed. 

By Samantha Liss • Jan. 31, 2023

Biden admin moves to undo moral opt-out to ACA contraceptive mandate

The rule also would create an option allowing people enrolled in health coverage or plans provided by “objecting entities” to obtain contraceptive coverage.

By Ryan Golden • Updated Jan. 30, 2023

Louisiana sends cease-and-desist order to Express Scripts over delayed insurance claims

State officials began investigating Express Scripts in April after receiving multiple complaints from an independent pharmacy association over the Cigna-owned PBM’s handling of claims.

By Rebecca Pifer • Updated Jan. 31, 2023

Cigna sues CVS, former pharmacy head Bricker over exec’s departure

In a lawsuit filed Thursday, Cigna alleged that Amy Bricker’s appointment to chief product officer of CVS’s consumer segment places the payer’s trade secrets at risk and violates her noncompete agreement.

By Rebecca Pifer • Jan. 27, 2023

Employers ‘disappointed’ in health plan performance, study finds

Health plans earned a lower average rating in the Leapfrog Group’s latest rankings than in previous years.

By Hailey Mensik • Jan. 26, 2023

Upcoming Medicaid redeterminations could hamper hospitals, payers

Medicaid eligibility checks beginning in April will likely curb hospital revenue and enrollment growth for payers, Moody's Investors Service said in a report.

By Hailey Mensik • Jan. 26, 2023

Record-breaking 16.3M people signed up for ACA coverage

The 2023 enrollment numbers reflect a broader policy push from the Biden administration to increase insurance coverage, especially during the pandemic.

By Sydney Halleman • Jan. 25, 2023

Will Elevance’s Louisiana acquisition kick off BCBS consolidation wave?

The proposed purchase reminds some industry experts of a period beginning in the 1990s, when nonprofit BCBS plans were acquired by for-profit groups.

By Samantha Liss • Jan. 25, 2023

Elevance reports $6B profit in 2022 on higher medical membership

The results come days after the insurer said it plans to buy Blue Cross and Blue Shield of Louisiana, a deal that would expand its reach to 15 states. 

By Samantha Liss • Jan. 25, 2023

CVS, Rush partner on new ACO for Chicago Medicare patients

Rush University will be the only Chicago-area academic medical center participating in CVS’ first accountable care organization in ACO REACH.

By Rebecca Pifer • Jan. 24, 2023

Elevance to acquire Blue Cross and Blue Shield of Louisiana

The deal will add 2 million members to Elevance’s rolls and push the insurer into its 15th state.

By Samantha Liss • Jan. 24, 2023

Cigna-owned Express Scripts taps new president

Previously, Adam Kautzner led pharmaceutical and retail network contracting and drug sourcing as vice president of supply chain for the PBM and Accredo Pharmacy.

By Sydney Halleman • Jan. 19, 2023

Major government ACOs to cover 13.2M people this year

Accountable care organizations and value-based care advocates cheered the news, with the National Association of ACOs calling 2023 a “turning point” for growth.

By Rebecca Pifer • Jan. 18, 2023

Uninsured rate fell for those historically lacking coverage

Researchers in an HHS report said policies like Medicaid continuous coverage and premium tax credits were key to the reduction.

By Shannon Muchmore • Jan. 17, 2023

UnitedHealth, flush off 2022 momentum, eyes membership, value-based growth

Looking forward, UnitedHealth expects growth of its membership rolls, an increase in fully capitated lives in Optum Health and an acceleration of Optum Insight’s integration with Change Healthcare.

By Rebecca Pifer • Jan. 13, 2023

California files suit against PBMs over insulin prices

The state filed suit Thursday against pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx, alleging they worked with drugmakers to drive up the price of insulin.

By Hailey Mensik • Jan. 13, 2023

Extended subsidies boost ACA marketplace enrollment

Nearly 16 million people have signed up for health coverage through the Affordable Care Act marketplace since open enrollment began Nov. 1

By Hailey Mensik • Jan. 11, 2023

Key trends for payers and providers in 2023

Providers are likely to clash with payers over rate hikes after a year of intense cost pressures.

By Samantha Liss • Jan. 11, 2023

Sen. Bernie Sanders to target high healthcare costs as leader of influential committee

The longtime Congressman and “Medicare for All” proponent will soon assume leadership of the Senate HELP committee, giving him sway in one of the nation’s most broadly influential health policy forums.

By Sydney Halleman • Jan. 9, 2023