Payer: Page 4
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Samantha Liss/Healthcare Dive
Centene wins New Hampshire Medicaid contract
It’s not yet clear how much the new Medicaid managed care contract is worth. The state’s previous contract with insurers, including Centene, allocated $6 billion in funds over five years.
By Rebecca Pifer • Jan. 19, 2024 -
Gerenme via Getty Images
Bright Health rebrands as NeueHealth, distances itself from insurance portfolio
After exiting the insurance business, the tech company will focus on providing care support and solutions for consumers and providers.
By Susanna Vogel • Jan. 18, 2024 -
Explore the Trendline➔
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TrendlineSocial determinants of health
The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.
By Healthcare Dive staff -
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Humana slashes 2023 profit outlook as high medical costs continue
The insurer also lowered its expectations for Medicare Advantage membership growth this year to below the industry average.
By Rebecca Pifer • Jan. 18, 2024 -
ipopba via Getty Images
Top healthcare trends in 2024
Here’s what industry experts see coming down the pike for hospitals, insurers and digital health companies this year.
By Healthcare Dive Staff • Jan. 18, 2024 -
Scott Eisen via Getty Images
Cigna CFO takes on expanded role as head of benefits division
Brian Evanko will serve as president and CEO of the Cigna Healthcare insurance division in addition to his position as chief financial officer.
By Emily Olsen • Jan. 17, 2024 -
Gerenme via Getty Images
Rising health insurance premiums linked to wage stagnation, study finds
Families with employer-sponsored plans missed out on an average of more than $125,000 in earnings over more than three decades as premiums increased, according to a study published in JAMA Network Open.
By Emily Olsen • Jan. 17, 2024 -
Alex Wong / Staff via Getty Images
CMS finalizes rule tightening prior authorization turnaround for insurers
Payers have new deadlines to issue prior authorization decisions — 72 hours for urgent requests and seven days for non-urgent ones — that should cut back coverage determination limbo for patients.
By Rebecca Pifer • Jan. 17, 2024 -
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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 Rebecca Pifer • Jan. 16, 2024 -
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Deep DiveTrends 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 Rebecca Pifer • Jan. 16, 2024 -
Courtesy of UnitedHealth Group
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 Rebecca Pifer • Jan. 12, 2024 -
Adeline Kon/Healthcare Dive/Healthcare Dive
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 Rebecca Pifer • 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 Sydney Halleman • Jan. 10, 2024 -
Courtesy of Walgreens
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 Rebecca Pifer • Jan. 9, 2024 -
Permission granted by Elevance Health
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 Rebecca Pifer • Jan. 8, 2024 -
erdikocak via Getty Images
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 -
Bruce Bennett via Getty Images
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 Rebecca Pifer • Jan. 5, 2024 -
Julia Rendleman via Getty Images
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 -
Getty Images via Getty Images
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 -
Courtesy of UnitedHealth Group
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 -
Joe Raedle/Getty Images via Getty Images
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 -
dventtr via Getty Images
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 -
AndreyPopov via Getty Images
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 Rebecca Pifer • Dec. 20, 2023 -
Kameleon007 via Getty Images
Medicaid redeterminationsBiden 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 -
Alex Wong via Getty Images
Surprise BillingNo 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 -
Permission granted by Elevance Health
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 Rebecca Pifer • Dec. 18, 2023
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