Payer: Page

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    Surprise Billing

    Texas judge rules to vacate more No Surprises Act regulations

    The ruling, which targets guidance related to the independent dispute resolution process, prompted the CMS to again pause all federal disputes.

    By • Aug. 28, 2023
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    Shared Savings ACOs saved Medicare $1.8B in 2022

    Nearly two-thirds of participating accountable care organizations earned payments for their performance last year, according to the CMS.

    By Emily Olsen • Aug. 25, 2023
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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
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    CVS launches new venture in biosimilar drug experiment

    The subsidiary, called Cordavis, will work directly with manufacturers to market or co-produce low-cost biologic drugs, starting with Novartis’ Humira copy.

    By Jonathan Gardner • Aug. 24, 2023
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    Cigna removes prior authorizations for 25% of services

    The insurer also plans to nix another 500 codes for its Medicare Advantage plans before the end of this year.

    By • Aug. 24, 2023
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    Large employers predict pharmacy spend, mental health needs will continue to rise

    “The road ahead for prescription drug and pharmacy looks quite daunting,” said the CEO of the Business Group on Health following a recent survey.

    By • Aug. 23, 2023
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    MA beneficiaries like their plans, but few say it’s easy to find care

    Trust and the ability to resolve problems or complaints were factors most highly correlated with members’ likelihood of renewing their plans, according to a new J.D. Power study.

    By Emily Olsen • Aug. 23, 2023
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    Florida sued over Medicaid redeterminations

    Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicaid coverage without proper notice.

    By • Aug. 23, 2023
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    CVS layoffs hit Rhode Island, Connecticut, New York and more

    The layoffs disclosed late last week to state labor departments include 770 employees in CVS’ Rhode Island headquarters, and about 520 workers at health insurer Aetna’s Connecticut hub.

    By • Aug. 21, 2023
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    Ground ambulance billing committee skeptical of IDR process

    A key congressional advisory group met last week to deliberate preventing unexpected bills after medical transport, but said the status quo dispute resolution process isn’t the solution.

    By • Aug. 17, 2023
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    Blue Shield of California drops CVS Caremark in pharmacy benefit overhaul

    BSCA has kicked CVS Caremark, the largest pharmacy benefit manager in the country, to the curb and is electing to carve out various pharmacy functions with companies like Amazon instead.

    By • Updated Aug. 17, 2023
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    Courtesy of Kroger
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    Kroger, Intermountain subsidiary Select Health launch co-branded MA plan

    It's the grocery chain's third MA plan in partnership with a health insurer. Kroger also operates plans with Elevance and Priority Health.

    By • Aug. 16, 2023
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    CMS tweaks ACO REACH to stabilize model

    Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to form groups to manage care and costs for fee-for-service Medicare enrollees.

    By • Aug. 15, 2023
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    Deep Dive

    Will the Biden administration’s short-term plan rule increase the uninsured rate?

    Free-market advocates argue proposed restrictions on short-term plans will leave consumers without coverage. Health policy researchers aren’t so sure.

    By • Aug. 14, 2023
  • CFOs should carefully assess their vendor choices to improve the quality of care for employees and decrease the cost curve.
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    AdventHealth sues MultiPlan for alleged ‘cartel’ with health insurers to fix prices

    The health system alleges providers have lost at least $19 billion per year as a direct result of MultiPlan’s anticompetitive agreements with major payers, including UnitedHealth, Aetna and Elevance.

    By • Aug. 14, 2023
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    UnitedHealth Group
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    DOJ hits UnitedHealth, Amedisys with second request over $3.3B deal

    The request for more information pushes back the timeline of the merger as regulators take a more active stance in healthcare M&A oversight.

    By • Aug. 11, 2023
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    MA bonuses reach record high, with UnitedHealthcare, Humana biggest winners

    Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.

    By • Aug. 10, 2023
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    Hospital prices twice as high for commercial plans than MA when negotiated by same payer, study finds

    Large national insurers had higher price ratios than other payers, an analysis in Health Affairs found.

    By Emily Olsen • Aug. 9, 2023
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    Smaller insurers tout progress toward profitability in Q2

    Clover notched its first quarterly adjusted EBITDA profit as a public company, while Oscar reached total company profitability for the second quarter in a row. Meanwhile, Bright posted its first quarter ever with positive adjusted EBITDA.

    By • Aug. 9, 2023
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    5 takeaways from health insurers’ second-quarter earnings

    UnitedHealth, CVS, Elevance and peers sidestepped the worst of medical cost growth in the quarter, but many payers face uncertainty from Medicare Advantage star ratings, GLP-1s and other pressures.

    By • Aug. 8, 2023
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    Permission granted by Elevance Health
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    Elevance snags Moody’s exec for new CFO

    Current CFO John Gallina is leaving Elevance after almost three decades in various leadership roles, including seven years as CFO.

    By • Aug. 8, 2023
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    Texas judge rules in favor of doctors in latest suit over surprise billing process

    The decision is expected to increase the number of claims providers file in the independent dispute resolution process, especially for smaller amounts, according to a health lawyer.

    By • Aug. 7, 2023
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    UnitedHealth Group
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    Former CMS, BCBS exec steps up as CEO of OptumRx in UnitedHealth leadership shakeup

    In a chain reaction of executive moves, Patrick Conway is replacing Heather Cianfrocco as CEO of UnitedHealth’s pharmacy benefit manager.

    By • Aug. 4, 2023
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    Health insurers ignore surprise billing decisions, providers allege

    Payers didn’t reimburse doctors in more than half of arbitration award cases, according to a survey from clinician group Americans for Fair Health Care.

    By • Aug. 4, 2023
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    Kentucky sues major PBMs over rising insulin prices

    A string of states and cities have filed recent suits against PBMs and drug manufacturers alleging they work in tandem to raise the cost of insulin.

    By • Aug. 4, 2023
  • A sign advertises Cigna's free health screenings as the Cigna HIT tour takes to the beach on May 31, 2019 in Virginia Beach, Virginia.
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    Cigna checks medical cost growth as Evernorth earnings boosted by GLP-1s

    Cigna’s medical costs in the quarter were “well-controlled,” one analyst said, but faced pressure from higher estimated risk-adjustment payments in the ACA individual exchanges.

    By • Aug. 3, 2023