More funding for cultural outreach is imperative to curb procedural Medicaid disenrollments

Investing in appropriate outreach as states resume eligibility checks is both humane and economically efficient, argues Jackie Leung, a public health researcher and professor at Linfield University.

By Jackie Leung • July 6, 2023

CMS proposes $375M reimbursement cut to home health agencies

Industry groups argue the payment cuts will exacerbate an already shaky financial situation for home health providers.

By Emily Olsen • July 5, 2023

Rural health startup Homeward names long-standing Centene executive to board

Brent Layton’s experience scaling Centene could help Homeward as it looks to grow and transform its rural healthcare services.

By Brian T. Horowitz • July 5, 2023

Georgia’s Medicaid work requirements pricier, more restrictive than full expansion

By only enacting a partial expansion, the state is forgoing $1.1 billion in federal funding and harming access to coverage, according to a new report.

By Rebecca Pifer Parduhn • June 30, 2023

Molina lowers price of Bright Health’s California MA plans

Bright Health will get less money than expected for its California Medicare Advantage unit, after agreeing to lower its sale price from $510 million to $425 million.

By Emily Olsen • Updated Dec. 18, 2023

Healthcare costs will grow 7% next year, PwC finds

Providers are expected to seek rate increases from payers as they struggle with labor costs, while health plans will face pressure from increased pharmaceutical expenses.

By Emily Olsen • June 29, 2023

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

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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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