Payer: Page

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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 • Jan. 16, 2024
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    Deep Dive

    Trends 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 • Jan. 16, 2024
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    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
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    Courtesy of UnitedHealth Group
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    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 • Jan. 12, 2024
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    Adeline Kon/Healthcare Dive/Healthcare Dive
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    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 • 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 • Jan. 10, 2024
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    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 • Jan. 9, 2024
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    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 • 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 • 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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    Courtesy of UnitedHealth Group
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    UnitedHealth to sell Brazilian unit Amil

    The deal, which is expected to close in the first half of the year, includes Amil Insurance, Amil Integrated Care, Amil Dental and Americas Hospitals in Brazil.

    By Emily Olsen • Jan. 2, 2024
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    Over 19M could enroll in ACA plans for 2024, CMS says

    Enrollment in the Affordable Care Act exchanges could be boosted by extended subsidies and the effects of Medicaid redeterminations.

    By Emily Olsen • Dec. 21, 2023
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    Shared Savings Program linked to net losses in traditional Medicare, study finds

    However, the program was associated with savings in Medicare Advantage and for the CMS overall.

    By Emily Olsen • Dec. 20, 2023
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    UnitedHealth, OptumRx sued by independent pharmacy over ‘unconscionable’ fees

    Osterhaus Pharmacy in Iowa — which is also suing CVS Caremark — is taking issue with pharmacy benefit managers’ use of performance-based fees that it says are contributing to independent pharmacy closures.

    By • Dec. 20, 2023
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    Medicaid redeterminations

    Biden administration urges 9 states to curb high child Medicaid, CHIP disenrollments

    Nine states account for about 60% of the decline in children’s Medicaid and Children’s Health Insurance Program enrollment from March through September, according to data from the CMS.

    By Emily Olsen • Dec. 19, 2023
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    Surprise Billing

    No Surprises Act dispute portal reopens again amid ‘challenging’ policy rollout

    The CMS has repeatedly stopped and restarted arbitration this year as court cases snarl regulatory efforts to resolve surprise billing disputes.

    By Susanna Vogel • Dec. 18, 2023
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    Elevance, BCBSLA resurrect $2.5B merger

    The insurers are bringing a new plan to the table they think will assuage regulatory concerns after Elevance and BCBSLA shelved their proposed merger following public outcry in Louisiana.

    By • Dec. 18, 2023
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    Kerianne Condon/Healthcare Dive
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    Sponsored by Zelis

    [Podcast] Inside Healthcare APIs

    This podcast series by Zelis explores how APIs can be leveraged to improve efficiency, offer a better experience, and drive innovation in the healthcare space.

    Updated Feb. 20, 2024
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    CMS asks health plans, PBMs to ease up on independent pharmacies

    A new letter urges payers to put in place special payment arrangements with pharmacies before a new policy kicks in that could reduce how much pharmacies are paid upfront.

    By • Dec. 15, 2023
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    Health spending growth normalized in 2022 post-COVID, CMS says

    Healthcare spending grew 4.1% in 2022, faster than 2021’s growth but notably slower than 2020’s, according to government actuaries.

    By • Dec. 14, 2023
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss/Healthcare Dive
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    Centene tries to quell concerns of ACA overhaul during investor day

    The Affordable Care Act has been under fire from Republican presidential candidates heading into an election year. But “once you giveth you cannot taketh away,” said the head of external affairs for the major marketplace carrier.

    By • Dec. 13, 2023
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    Humana used algorithm to deny care to Medicare Advantage patients, lawsuit claims

    The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.

    By Susanna Vogel • Dec. 13, 2023
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    House passes bill targeting price transparency, site-neutral payments, PBMs

    Hospitals have lobbied against the site-neutral payment policies included in the bipartisan legislation.

    By • Dec. 12, 2023
  • CFOs should carefully assess their vendor choices to improve the quality of care for employees and decrease the cost curve.
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    Health costs grew in line with overall inflation in 2023, new Turquoise data shows

    The findings — some of the first from new price transparency data — illustrate how overall economic inflation could be catching up to faster health cost growth.

    By • Dec. 12, 2023