Payer: Page

  • Kelly Bliss Teladoc headshot
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    Adeline Kon/Healthcare Dive
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    Q&A // HLTH23

    AI, M&A and MSK: Teladoc’s head of group health shares vendor’s strategic priorities

    Kelly Bliss discussed how the virtual care giant is approaching the three buzzy acronyms in an interview at HLTH.

    By • Oct. 12, 2023
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    Permission granted by Elevance Health
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    Elevance confirms ‘adjustments’ to resources as employees report job cuts

    Elevance, formerly known as Anthem, employs nearly 100,000 people and serves more than 117 million customers, according to the company.

    By Emily Olsen • Oct. 12, 2023
  • Explore the Trendline➔
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    Yujin Kim/Healthcare Dive
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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
  • Humana CEO Bruce Broussard
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    Michael Loccisano / Staff via Getty Images
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    Humana CEO to step down next year

    Jim Rechtin, president and CEO of physician staffing firm Envision Healthcare, will take the reins as chief executive of the payer in the latter half of 2024.

    By Emily Olsen • Oct. 11, 2023
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    Scott Eisen via Getty Images
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    HLTH23

    Cigna’s Evernorth acquires Bright.md’s asynchronous care tech

    Evernorth’s telehealth business MDLive plans to start offering asynchronous care using the new capabilities within its virtual urgent care platform in 2024.

    By • Oct. 10, 2023
  • A smartphone displays Uber's new health benefits card functionality.
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    Courtesy of Uber
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    HLTH23

    Uber adds Optum-enabled benefits cards to health platform

    The new deal has made Uber a “patient entry point” into the health benefits system, according to Uber Health global lead Caitlin Donovan.

    By • Oct. 9, 2023
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    "Aetna Office Bldg II" by Montgomery County Planning Commission is licensed under CC BY-SA 2.0
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    Aetna may have received $25.5M in MA overpayments for 2015 and 2016, audit finds

    Medical records provided by the insurer didn’t support certain diagnosis codes, resulting in overpayments, according to an audit from the HHS Office of the Inspector General.

    By Emily Olsen • Oct. 6, 2023
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    Getty Images
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    Top healthcare conferences in 2024

    From digital health events to payer and provider summits, here are upcoming healthcare conferences for the organized executive to keep in mind.

    By • Updated Dec. 4, 2023
  • Mergers and acquisitions
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    Froedtert signs deal with Ascension Wisconsin to take full ownership of health plan

    The Milwaukee-based health system plans to buy the remaining 50% stake in Network Health, which offers commercial and Medicare plans in 23 Wisconsin counties.

    By Emily Olsen • Oct. 4, 2023
  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    Warren, Jayapal call for closer scrutiny of UnitedHealth-Amedisys deal

    The progressive lawmakers sent a letter to top antitrust regulators urging heightened attention to the $3.3 billion transaction, which is currently under investigation by the Department of Justice.

    By • Oct. 4, 2023
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    Getty Images
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    Molina loses anticipated Indiana Medicaid contract

    The health insurer expected to be offered a contract to manage the care of Medicaid seniors in a new long-term services and supports program, but wasn’t able to stand up a dual-eligible special needs plan in time.

    By • Oct. 3, 2023

  • Anthem, Bon Secours reach contract agreement through 2028

    The new contract puts to bed four years of tense network disputes between the Catholic health system and the Elevance subsidiary.

    By • Oct. 2, 2023
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    Matt Slocum/AP

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    Cigna pays $172M to settle MA upcoding allegations

    The agreement settles a whistleblower lawsuit against Cigna that the Department of Justice joined last year, and requires the payer to undergo annual auditing from an independent entity.

    By • Oct. 2, 2023
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    Getty Images
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    CMMI increased federal spending by $5.4B during its first decade, report finds

    The Congressional Budget Office report estimated the Center for Medicare and Medicaid Innovation, which was created in part to reduce spending, will increase net federal spending by $1.3 billion from 2021 through 2030.

    By Emily Olsen • Sept. 29, 2023
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    Getty Images
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    Congressional Democrats open investigation into Medicaid MCOs over claims denials

    Sen. Ron Wyden, D-Ore., and Rep. Frank Pallone, D-N.J., sent letters requesting information on coverage denials to seven payers, including UnitedHealthcare, Aetna and Centene.

    By • Sept. 29, 2023
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    Scott Olson via Getty Images
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    CVS hit with lawsuit from independent pharmacy over fees

    A small Iowa pharmacy is accusing CVS Caremark of forcing independent pharmacies to sign one-sided contracts in order to stay in its network and continue dispensing drugs for its millions of covered lives.

    By • Sept. 28, 2023
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    Getty Images
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    MA premiums increase slightly for 2024

    CVS, UnitedHealth and Humana expanded their MA footprints 13%, 4% and 2% respectively for next year, according to an analyst analysis of the CMS data.

    By • Sept. 27, 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 lays off 3% of workforce

    The insurer has been struggling with headwinds from Medicaid redeterminations and MA star ratings. The layoffs follow similar workforce reductions at CVS Health earlier this summer.

    By • Sept. 27, 2023
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    Adeline Kon/Healthcare Dive/Healthcare Dive
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    Cano sells Texas, Nevada centers to Humana subsidiary for $67M

    The divestiture to Humana’s CenterWell Senior Primary Care business comes after Cano this summer said it was exploring a potential sale amid its worsening liquidity position.

    By • Sept. 26, 2023
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Permission granted by Elevance Health
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    Elevance, BCBSLA pause $2.5B merger amid regulatory scrutiny

    The health insurers originally expected their merger to close before the end of 2023, but have hit snags receiving the regulatory green light in Louisiana.

    By • Sept. 26, 2023
  • A picture of the exterior of the US Department of Health and Human Services. In front of the building is a black sign designating the building's name.
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    Alex Wong via Getty Images
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    CMS to get ‘tougher’ on Medicare Advantage, official promises

    Deputy Administrator Jon Blum signaled regulators could increasingly crack down on bad actors in the MA program, which now covers more than half of Medicare seniors.

    By • Sept. 22, 2023
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    Alex Wong via Getty Images
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    Federal agencies propose increase to No Surprises Act administrative fees

    On Thursday, the HHS and other departments proposed a rule that would raise the independent dispute resolution process fees from $50 to $150. Last month, a federal court vacated a rate of $350.

    By Susanna Vogel • Sept. 22, 2023
  • a medicaid insurance card on top of a small American flag
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    Getty Images
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    CMS requires 30 states to pause Medicaid disenrollments after systems error

    Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.

    By Emily Olsen • Sept. 22, 2023
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    Matt Slocum/AP

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    Cigna hit with second class action suit over claims automation software

    The lawsuit filed in Connecticut seeks class action status to represent all consumers nationwide who had claims reviewed by PxDx.

    By • Sept. 20, 2023
  • A view of the front of the U.S. Capitol building framed by green-leaf trees against a clear blue sky.
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    Permission granted by Dan Zukowski
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    Frustration over surprise billing implementation builds in House hearing

    Bipartisan lawmakers joined together to voice concerns about the implementation of the No Surprises Act, which critics say has created barriers to care.

    By Susanna Vogel • Sept. 20, 2023
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    Anna Moneymaker via Getty Images
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    Home health advocates raise alarm over payment cuts, access to care

    A new payment model and reimbursement cuts are straining home health agencies, but more data may be needed to fully evaluate the model, advocates and researchers said during a Senate finance committee hearing.

    By Emily Olsen • Sept. 20, 2023