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Matt Slocum/AP
Cigna pulls out of Humana deal: WSJ
Cigna and Humana are abandoning merger discussions less than two weeks after news of the potential deal dropped, following a less-than-positive market reaction.
By Rebecca Pifer Parduhn • Dec. 11, 2023 -
Catherine Douglas Moran/Healthcare Dive
Kroger’s new benefits program expands access to affordable food
The tie-up with a healthcare technology company lets Medicare Advantage, Medicaid and other employer benefits program recipients use services at the grocer’s pharmacies as well as buy eligible food and over-the-counter items.
By Catherine Douglas Moran • Dec. 7, 2023 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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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Clover Health exits ACO REACH
The beleaguered insurer will leave the accountable care program at the end of the 2023 performance year following disappointing results in Medicare direct contracting.
By Rebecca Pifer Parduhn • Dec. 6, 2023 -
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CMS says states could lose funding over Medicaid redeterminations issues
The interim final rule comes as nearly 11.8 million people have been removed from the safety-net insurance.
By Emily Olsen • Dec. 5, 2023 -
Scott Olson via Getty Images
CVS overhauls how its retail pharmacies charge for prescription drugs
Under the new model, CVS’ pharmacy network will price drugs based on the amount the company paid for them, plus a defined markup and additional pharmacist fee.
By Rebecca Pifer Parduhn • Dec. 5, 2023 -
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Deep DiveA Cigna-Humana merger could face a long regulatory delay. But it might get approved.
As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.
By Rebecca Pifer Parduhn • Dec. 4, 2023 -
Permission granted by Pegasystems
Sponsored by PegasystemsEnhanced human potential: How customer service technology increases empathy
Elevance Health’s Geeta Wilson talks about improving operational efficiencies while enhancing member and associate satisfaction.
By Christopher Patterson, VP Product Strategy, Pegasystems • Dec. 4, 2023 -
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North Carolina Medicaid expansion kicks in
About 600,000 more people in the state now have access to the safety-net insurance coverage.
By Rebecca Pifer Parduhn • Dec. 1, 2023 -
Courtesy of UnitedHealth Group
Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook
UnitedHealth’s MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers, management said during an investor day.
By Rebecca Pifer Parduhn • Nov. 30, 2023 -
Illustration: Xavier Lalanne-Tauzia for Industry Dive
Highmark Health’s insurance business boosts earnings
The insurance arm pushed the healthcare parent company to positive results during the first nine months of 2023 after its provider arm, Allegheny Health, reported an operating loss.
By Susanna Vogel • Nov. 29, 2023 -
Matt Slocum/AP
Cigna, Humana in talks to merge: WSJ
The merger would have major effects on the makeup of the U.S. health insurance industry, and would almost certainly face a regulatory challenge.
By Rebecca Pifer Parduhn • Nov. 29, 2023 -
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Global medical costs to dip in 2024 — but respite may not last long, research finds
Medical costs will continue to rise over the next few years, according to WTW. Surveyed insurers blamed expensive medical technologies and an overuse of health services.
By Susanna Vogel • Nov. 29, 2023 -
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Majority of Medicaid enrollees satisfied with plans, despite flaws, survey finds
Medicaid enrollees are more likely to understand and be satisfied with their plans, despite reporting poorer health outcomes, according to a new report from KFF.
By Susanna Vogel • Nov. 29, 2023 -
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Sponsored by PegasystemsAI to take center stage in healthcare in 2024
Five predictions on how AI will change healthcare.
By Robert Connely, Global Market Leader for Healthcare, Pegasystems • Nov. 27, 2023 -
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Average per-worker cost of health benefits rose by 5.2% in 2023: survey
Inflation is a contributor to the increase, but rising prescription drug costs are likely to have a longer-term impact, according to a Mercer report.
By Emily Olsen • Nov. 22, 2023 -
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Insurers’ financial outlook stable despite higher MA utilization: Moody’s
Publicly traded health insurers’ financial results held steady in the third quarter, boosted by strong investment income and membership growth, according to the credit ratings agency.
By Emily Olsen • Nov. 22, 2023 -
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CMS proposes stricter network adequacy standards for plans in state-run ACA exchanges
Beginning in 2025, plans sold in state-based exchanges would be required to meet time and distance standards for provider access under a new rule proposed Wednesday.
By Rebecca Pifer Parduhn • Nov. 16, 2023 -
Samantha Liss/Healthcare Dive
Centene names new COO following leadership turnover
Current SVP Susan Smith will take the reins as the health insurer’s chief operating executive starting next year.
By Rebecca Pifer Parduhn • Nov. 15, 2023 -
Courtesy of UnitedHealth Group
UnitedHealth sued over use of algorithm to deny care for MA members
The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.
By Rebecca Pifer Parduhn • Nov. 15, 2023 -
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State Medicaid officials project enrollment nosedive next year amid unwinding
Enrollment in the safety-net insurance program could plummet 8.6% in the 2024 fiscal year — the largest year-over-year drop since 1998, according to KFF.
By Rebecca Pifer Parduhn • Nov. 14, 2023 -
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New AMA policies focus on GLP-1 coverage, resisting corporate medicine
The lobbying group advanced a range of policy resolutions it says will advance access to patient care at its annual interim meeting.
By Susanna Vogel • Nov. 14, 2023 -
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Sponsored by Rise to Health CoalitionHow payers can advance health equity as part of coordinated action
When discussing the gap between the status quo and safe, high-quality healthcare, many organizations realize that improving health equity is a moral and economic imperative as the business case for equity is well-documented.
Nov. 13, 2023 -
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Optum Rx moves 8 insulins to preferred formulary status as pressure mounts on PBMs
The drugs shifting to preferred status — meaning they’ll be available for under $35 per month in out-of-pocket costs — were previously on tier three or excluded altogether from the pharmacy benefit manager’s formulary lists.
By Rebecca Pifer Parduhn • Nov. 10, 2023 -
Medicare Advantage seniors have better health outcomes, study finds
New research from Harvard and Inovalon found MA beneficiaries had fewer hospital readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use than those in traditional Medicare.
By Rebecca Pifer Parduhn • Nov. 9, 2023 -
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Biggest takeaways from health insurers’ third-quarter earnings
Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics? Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s.
By Rebecca Pifer Parduhn • Nov. 8, 2023
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