U.S reaches record low uninsured rate just prior to Medicaid redeterminations

The uninsured rate fell to a record low in March, but Medicaid eligibility checks could reverse that progress, according to experts.

By Susanna Vogel • Aug. 3, 2023

UnitedHealth unit sued by Labor Department over systematic claims denials

The government is alleging plan administrator UMR improperly denied thousands of ER and drug screening claims submitted between 2015 and 2018.

By Susanna Vogel • Aug. 2, 2023

Explore the 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

CVS announces restructuring plan after profit falls 37%

CVS also lowered its 2024 earnings outlook, citing cost pressures, and said investors should no longer rely on its 2025 target.

By Rebecca Pifer Parduhn • Aug. 2, 2023

Humana reports lower-than-feared medical costs, raises MA membership growth outlook

Humana’s stock rose following the earnings, which — along with comments from other payers — suggest the uptick in outpatient care flagged earlier in the quarter is moderating.

By Rebecca Pifer Parduhn • Aug. 2, 2023

CVS to lay off 5K employees amid cost pressures

The job cuts come as CVS faces hefty integration costs from recent M&A, including its $10.6 billion buy of Oak Street and $8 billion acquisition of Signify.

By Rebecca Pifer Parduhn • Aug. 1, 2023

Elevance rebrands Amerigroup segment as Wellpoint

The return of the Wellpoint brand for Amerigroup, which covers Medicaid and Medicare members, is the payer's latest corporate reinvention.

By Rebecca Pifer Parduhn • Aug. 1, 2023

Hospital, payer lobbies urge CMS to reconsider ‘conflicting’ prior authorization standards

The groups, normally at odds, have found a source of agreement in proposed rules meant to standardize data exchange processes.

By Brian T. Horowitz • July 31, 2023

CMS releases April Medicaid unwinding data. Total disenrollments top 3.8M

The highly-anticipated data pegging the nation’s procedural disenrollment rate at 80% is higher than more recent estimates.

By Rebecca Pifer Parduhn • July 28, 2023

Centene’s 2024 outlook hampered by Medicaid redeterminations

The payer lost 262,700 Medicaid members in the second quarter, dropping its total Medicaid lives to just over 16 million.

By Rebecca Pifer Parduhn • July 28, 2023

Nevada to shut down Friday Health Plans

State regulators will liquidate the failing insurtech, leaving about 3,000 enrollees to look for new coverage.

By Emily Olsen • July 27, 2023

Molina reports Medicaid redeterminations proceeding as expected

Despite concerns about high early levels of disenrollments, the payer lost 93,000 Medicaid members during the second quarter — well within forecasts, CEO Joe Zubretsky said.

By Rebecca Pifer Parduhn • July 27, 2023

Microsoft, Blue Shield partner to develop integrated data hub

The hub, which the companies are calling “The Blue Shield Experience Cube,” will create an integrated digital health record as its first use case.

By Brian T. Horowitz • July 27, 2023

Cleveland sues major PBMs, drug manufacturers over rising insulin prices

The suit argues that PBMs, including CVS Caremark, Express Scripts and OptumRx, use their market power to drive up the cost of insulin for Cleveland residents — approximately 17% of whom are diabetic. 

By Sydney Halleman • July 26, 2023

Biden administration cracks down on payers over mental health coverage

A new proposed rule from the HHS and Treasury and Labor departments would require health insurers to analyze patient outcomes to ensure their benefits are administered equally.

By Rebecca Pifer Parduhn • July 25, 2023

Cigna sued over algorithm allegedly used to deny claims

The lawsuit filed in a California district court argues the health insurer used the technology to “deny payment in batches of hundreds or thousands at a time,” violating state law.

By Rebecca Pifer Parduhn • July 25, 2023

ChenMed taps UnitedHealthcare veteran as new president

Family members at value-based medical group ChenMed are stepping down from leadership roles.

By Rebecca Pifer Parduhn • July 24, 2023

PE ownership worsens quality, raises costs, according to BMJ review

The analysis comes as private equity investments in healthcare soar and regulators look to crack down on roll-up acquisitions.

By Sydney Halleman • July 24, 2023

New antitrust merger guidelines could have significant chilling effect on healthcare deals

Regulators have historically struggled to make a case against complex and non-traditional tie-ups. That could change with the new guidelines.

By Rebecca Pifer Parduhn • July 21, 2023

Prior authorization denials could limit access in Medicaid managed care, OIG reports

Medicaid managed care organizations denied one out of every eight requests for prior authorization in 2019, and most states don’t regularly monitor if denials are appropriate, the HHS’ Office of the Inspector General found.

By Emily Olsen • July 20, 2023

CMS pausing Medicaid redeterminations in states noncompliant with renewal requirements

The Biden administration is cracking down on states in an effort to curb rampant procedural disenrollments from the safety-net program.

By Rebecca Pifer Parduhn • July 20, 2023

Elevance curbs elevated medical costs, raises 2023 forecast

Although it’s still early in the redeterminations process, Elevance is seeing “encouraging” signs that many Medicaid members who lose coverage are transitioning onto ACA plans, according to its CFO.

By Rebecca Pifer Parduhn • July 19, 2023

Patients and physicians pay the consequences for health plan delays

The chief medical officer at the Alliance for Patient Access argues for reforms to reduce burdens associated with prior authorization.

By David Charles • July 19, 2023

Returned UnitedHealth executive to lead Optum Health after stint at CVS

Amar Desai will become CEO of Optum’s care delivery organization after returning to UnitedHealth Group from CVS Health this spring.

By Emily Olsen • July 19, 2023

Colorado to shut down failing Friday Health Plans

State regulators had initially hoped the insurtech could operate for the rest of the year, but Colorado’s insurance division became concerned about Friday’s longevity after placing the insurer into rehabilitation.

By Emily Olsen • July 18, 2023

UnitedHealth beats Q2 expectations, despite medical cost growth fears

Rising outpatient utilization among seniors that spooked investors earlier in the quarter left the payer’s bottom line largely unscathed.

By Rebecca Pifer Parduhn • July 14, 2023