UnitedHealth, flush off 2022 momentum, eyes membership, value-based growth

Looking forward, UnitedHealth expects growth of its membership rolls, an increase in fully capitated lives in Optum Health and an acceleration of Optum Insight’s integration with Change Healthcare.

By Rebecca Pifer Parduhn • Jan. 13, 2023

California files suit against PBMs over insulin prices

The state filed suit Thursday against pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx, alleging they worked with drugmakers to drive up the price of insulin.

By Hailey Mensik • Jan. 13, 2023

Extended subsidies boost ACA marketplace enrollment

Nearly 16 million people have signed up for health coverage through the Affordable Care Act marketplace since open enrollment began Nov. 1

By Hailey Mensik • Jan. 11, 2023

Key trends for payers and providers in 2023

Providers are likely to clash with payers over rate hikes after a year of intense cost pressures.

By Samantha Liss • Jan. 11, 2023

Sen. Bernie Sanders to target high healthcare costs as leader of influential committee

The longtime Congressman and “Medicare for All” proponent will soon assume leadership of the Senate HELP committee, giving him sway in one of the nation’s most broadly influential health policy forums.

By Sydney Halleman • Jan. 9, 2023

Eisai, in pricing new Alzheimer’s drug, tries to sidestep controversy

The pharma set the average annual cost of it and Biogen’s newly approved medicine Leqembi to $26,500, below the cost of the companies’ earlier drug Aduhelm but above one estimate of cost effectiveness.

By Ned Pagliarulo • Jan. 9, 2023

FDA approves Alzheimer’s drug from Eisai, Biogen in closely watched decision

The agency’s approval comes months after a large clinical trial showed the drug, called Leqembi, could slow the disease’s progression. Yet experts have raised concerns about its safety.

By Jacob Bell • Jan. 6, 2023

California revises Medicaid contract awards, adding 2 insurers

Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country’s largest Medicaid market.

By Susan Kelly • Jan. 4, 2023

The portal to resolve surprise bills has been inundated with disputes — SCP Health tops the list

Federal agencies received more disputes in a five-month window than they expected to receive in a full year.

By Samantha Liss • Updated Jan. 9, 2023

Centene reaches $44M settlement with Iowa

It’s the latest deal in a string of settlements to resolve allegations the nation’s largest Medicaid managed care organization overcharged states for pharmacy services.

By Samantha Liss • Dec. 21, 2022

Stakes are high in California’s Medicaid market shakeup

Four insurers that lost out on lucrative contracts in the state’s first-ever competitive process are challenging the state's picks.

By Susan Kelly • Dec. 21, 2022

Judge questions surprise billing ban implementation during court hearing

A federal judge on Tuesday tested the government’s defense concerning a rule designed to help third parties resolve payment disputes between providers and insurers.

By Samantha Liss • Dec. 21, 2022

CMS rule aimed at improving Medicare Advantage draws praise

Proposed changes target prior authorization holdups and misleading advertising while aiming to expand access to behavioral health care and affordable prescriptions.

By Susan Kelly • Dec. 19, 2022

Texas Medical Association heads to court again in second challenge to surprise billing ban

The TMA is continuing to argue the surprise billing ban unfairly benefits insurers. It will argue before the same judge who previously sided with the group in a separate but similar case.

By Samantha Liss • Dec. 19, 2022

Virtual care and MA stars: value for seniors and for health plans

Kelly Bliss, Teladoc’s head of U.S. group health, makes the case for virtual care’s efficacy in improving MA star ratings.

By Kelly Bliss • Dec. 19, 2022

Centene again shakes up C-suite

The changes come as the insurer outlined its financial expectations for next year ahead of its investor day on Friday.

By Samantha Liss • Dec. 16, 2022

Healthcare leaders expect turbulent operating environment next year

Staffing challenges and high inflation are expected to continue into 2023, along with affordability issues for patients, shrinking margins and continual supply chain disruptions, according to a survey from Deloitte.

By Hailey Mensik • Dec. 16, 2022

Scan Group, CareOregon to merge, forming $6.8B health plan

Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.

By Samantha Liss • Dec. 15, 2022

For ALS patients, doctors, a new medicine reignites concerns about healthcare access

The drug Relyvrio is in high demand in ALS clinics across the U.S. Though some patients are already getting it, insurance coverage and out-of-pocket costs remain a source of anxiety.

By Jacob Bell , Shaun Lucas • Dec. 15, 2022

CMS estimates 41.5M people affected by innovation center models since late 2020

The Center for Medicare and Medicaid Innovation is currently operating 33 models studying potential improvements in healthcare payment and delivery.

By Rebecca Pifer Parduhn • Dec. 14, 2022

Bright Health in danger of being booted from NYSE

The insurtech, which went public last year, has struggled with medical costs during the pandemic and has shrunk its business over the past year.

By Rebecca Pifer Parduhn • Dec. 13, 2022

CMS tackles provider availability, exchange regulations in proposed rule

The regulation comes after the ACA exchanges, spurred by financial incentives during the COVID-19 pandemic, reached record enrollment numbers.

By Sydney Halleman • Dec. 13, 2022

Variability in Medicare direct contracting savings illustrates promises, pitfalls of value-based care

Accountable care organizations' net savings rates ranged from -29.4% to 29.2% in the 2021 Global and Professional Direct Contracting Model.

By Rebecca Pifer Parduhn • Updated Dec. 13, 2022

Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH

At least 10 organizations with records of healthcare fraud and abuse participated in the direct contracting program last year despite CMS screening requirements, the letter said.

By Rebecca Pifer Parduhn • Updated Dec. 20, 2022

Centene reaches $17M settlement with Oregon

The payer has reached settlements with 13 states over allegations it overcharged Medicaid programs.

By Samantha Liss • Dec. 9, 2022