Bright Health gets new CFO

Bright’s current SVP of finance Jay Matushak is stepping up after the current CFO elected to leave the post to pursue a new opportunity, the company said Wednesday.

By Rebecca Pifer Parduhn • May 4, 2023

Half of all Medicare beneficiaries are now enrolled in MA plans

Enrollment in MA plans has steadily increased since 2007, when one in five Medicare beneficiaries were enrolled in a private plan.

By Brian T. Horowitz • May 3, 2023

CVS lowers 2023 earnings outlook on Oak Street, Signify deal costs

The company’s recent big-ticket acquisitions are taking a toll on its financial outlook, though management told investors Wednesday the company still expects to reach its prior earnings targets for 2024 and 2025.

By Rebecca Pifer Parduhn • May 3, 2023

Envision wins $91M in arbitration against UnitedHealthcare

The arbitration panel found UnitedHealthcare “unilaterally reduced reimbursement to Envision clinicians,” in violation of its in-network agreement.

By Sydney Halleman • May 3, 2023

CVS closes $10.6B Oak Street Health buy

With the deal’s completion, CVS adds a multi-state chain of medical clinics for seniors to its primary care roster.

By Rebecca Pifer Parduhn • May 2, 2023

Bright Health explores sale of California MA business

The move, if completed, would mean the end of the company as a health insurer.

By Rebecca Pifer Parduhn • May 1, 2023

CMS targets Medicaid payment transparency, wait times in new proposed rules

The agency wants to create maximum waiting times for certain appointments in addition to requiring stronger quality monitoring and reporting standards for Medicaid and CHIP managed care plans.

By Sydney Halleman • April 28, 2023

Lawmakers show bipartisan support for site-neutral payments

Political will appears to be rising to equalize Medicare payments to hospitals and doctor’s offices for certain low-acuity services, according to lawmaker comments during a Wednesday hearing.

By Rebecca Pifer Parduhn • April 27, 2023

Molina expects half of Medicaid enrollees gained during COVID to lose eligibility due to redeterminations

Redeterminations, which began earlier this month, are not expected to result in a “significant margin impact,” Molina’s CEO said, as the payer raised its full-year guidance.

By Sydney Halleman • April 27, 2023

Kaiser names new chief digital officer

Nari Gopala has previously served in leadership positions at Amazon Web Services, Daybreak Game Company and Sony Online Entertainment.

By Shannon Muchmore • April 26, 2023

Humana boosts 2023 expectations for Medicare Advantage growth

The insurer reported favorable MA inpatient utilization as COVID-19 claims decreased in the first quarter.

By Shannon Muchmore • April 26, 2023

Centene lowers 2024 earnings guidance as Medicaid redeterminations roll out

The payer beat Wall Street expectations in the first quarter on both earnings and revenue, which reached $39 billion.

By Shannon Muchmore • April 25, 2023

AHIP’s new ad spot targets pharma over drug costs as Congress scrutinizes PBMs

The marketing push comes as lawmakers take a harder look at pharmacy benefit managers, drug purchasing middlemen that are often owned by health insurance companies.

By Rebecca Pifer Parduhn • April 25, 2023

Clover cuts 10% of workforce, moves core operations to UST HealthProof

Carrying out the restructuring will result in a charge of about $7 million to $9 million in the first half of 2023, the company reported.

By Brian T. Horowitz • April 19, 2023

Elevance sees revenue boost as it focuses on Medicaid redeterminations

The payer said it was pleased with the recent CMS decision to phase in risk adjustment changes to the Medicare Advantage program that would allow it to “smooth the impact” to beneficiaries and providers.

By Shannon Muchmore • April 19, 2023

CMS walks back limits on non-standardized plan options, finalizes marketplace standards

The final rule comes as a record 16.3 million Americans, spurred by COVID-19 incentives, signed up for ACA marketplace plans during 2023 open enrollment.

By Sydney Halleman • April 18, 2023

CVS Health names new president of Aetna

Brian Kane, who previously worked as a consultant and was CFO at Humana, will replace Daniel Finke, who is stepping down.

By Susan Kelly • April 18, 2023

UnitedHealth notches record revenue in first quarter

UnitedHealth’s growth, which resulted in a profit of $5.8 billion in the quarter, was “stronger than normal,” one analyst said.

By Rebecca Pifer Parduhn • April 14, 2023

Care access, affordability impeding long COVID patients, study finds

Survey respondents had difficulty finding clinicians and health insurance and struggled to keep up with family medical bills in the previous year.

By Brian T. Horowitz • April 12, 2023

A Texas judge just turned back the clock on healthcare

The wiping out of preventive service requirements under the Affordable Care Act would render millions unable to receive life-saving preventive procedures, the CEO of the American College of Preventive Medicine argues.

By Donna Grande • April 12, 2023

Last year was second-best ever for healthcare private equity deals, Bain finds

PE transactions were buoyed by a strong first half of the year, with deals declining in the second half due to tensions from Russia’s invasion of Ukraine and growing inflationary pressures.

By Sydney Halleman • April 11, 2023

New York judge denies UnitedHealth’s request for summary judgment in TeamHealth lawsuit

U.S. District Judge John Koeltl rejected UnitedHealth’s argument that New York’s surprise billing law prevents providers from taking legal action against payers for alleged underpayments.

By Rebecca Pifer Parduhn • April 7, 2023

CMS cracks down on MA coverage denials and misleading ads in final rule

Both hospital and payer groups came out in support of the rule finalized Wednesday, finding common ground in the need to streamline prior authorization.

By Rebecca Pifer Parduhn • April 6, 2023

Some patients still pay for ACA-mandated free preventive care, study finds

Researchers in the study found that more than a third of patients incurred out-of-pocket expenses on the day of their ACA-mandated free preventative medical care service.

By Sydney Halleman • April 5, 2023

UnitedHealth executive returns to company 6 months after leaving for CVS

Amar Desai is back at UnitedHealth as senior adviser to CEO Andrew Witty.

By Rebecca Pifer Parduhn • April 3, 2023