Kraft Heinz sues Aetna, says insurer breached ERISA fiduciary duties

Aetna wrongly retained millions in undisclosed fees and paid provider claims “that should have never been paid,” according to the lawsuit filed in a Texas federal court.

By Ryan Golden • July 13, 2023

States’ varying approaches complicate effort to determine impact of Medicaid redeterminations

Millions of people have been disenrolled from Medicaid, but it’s too early to get a full picture of redeterminations’ effect on vulnerable Americans, experts say.

By Emily Olsen • July 13, 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

Humana, Elevance, Centene downgraded days before second-quarter earnings kickoff

J.P. Morgan and Wolfe Research analysts cited uncertainty and pricing concerns in Medicare Advantage in addition to cost pressures in the commercial market when downgrading major U.S. payers.

By Rebecca Pifer Parduhn • July 13, 2023

CMS faces poor data quality in payment model health equity push

Variable race and ethnicity data is making it difficult to determine whether CMS Innovation Center models are reaching, enrolling and helping underserved beneficiaries, according to a new white paper from the agency.

By Rebecca Pifer Parduhn • July 12, 2023

CVS Caremark, GoodRx partner on automatic drug discounts for commercially insured

The program will be a source of revenue for GoodRx, and might also open a new fee stream for CVS’ pharmacy benefit manager as the drug middlemen face increased scrutiny for complex pricing models.

By Rebecca Pifer Parduhn • July 12, 2023

CMS to return $9B to 340B hospitals under new plan

Hospital groups said the proposed rule is an important step toward restitution for years of 340B underpayments, but they criticized regulators for proposed rate decreases and a lack of additional interest payments.

By Rebecca Pifer Parduhn • July 10, 2023

Home health industry group sues CMS, HHS over payment cuts

The National Association for Home Care and Hospice said regulators used “an illogical and invalid methodology” in a new payment model.

By Emily Olsen • July 7, 2023

Biden admin rolls back Trump-era expansion of short-term health plans

The proposed rule released Friday would limit short-term plan duration to up to four months. Stakeholders have been waiting for President Joe Biden to restrict access to the bare-bones coverage since he assumed office.

By Rebecca Pifer Parduhn • July 7, 2023

FDA grants Eisai’s Leqembi full approval, opening door to wider use of Alzheimer’s drug

The broader approval is expected to push insurers, namely Medicare, to increase coverage of amyloid-targeting therapies.

By Jacob Bell • July 6, 2023

MA beneficiaries more socioeconomically disadvantaged than FFS enrollees, report finds

People who enroll in privately-run MA plans are more likely to be non-white and have lower incomes, according to a white paper from Inovalon and Harvard Medical School.

By Emily Olsen • July 6, 2023

Medicare Advantage’s quality bonus program needs reform, Urban Institute argues

The QBP is a significant source of revenue for MA insurers, but generally doesn’t translate to higher quality care for beneficiaries, according to the nonprofit’s new report.

By Rebecca Pifer Parduhn • July 6, 2023

More funding for cultural outreach is imperative to curb procedural Medicaid disenrollments

Investing in appropriate outreach as states resume eligibility checks is both humane and economically efficient, argues Jackie Leung, a public health researcher and professor at Linfield University.

By Jackie Leung • July 6, 2023

CMS proposes $375M reimbursement cut to home health agencies

Industry groups argue the payment cuts will exacerbate an already shaky financial situation for home health providers.

By Emily Olsen • July 5, 2023

Rural health startup Homeward names long-standing Centene executive to board

Brent Layton’s experience scaling Centene could help Homeward as it looks to grow and transform its rural healthcare services.

By Brian T. Horowitz • July 5, 2023

Georgia’s Medicaid work requirements pricier, more restrictive than full expansion

By only enacting a partial expansion, the state is forgoing $1.1 billion in federal funding and harming access to coverage, according to a new report.

By Rebecca Pifer Parduhn • June 30, 2023

Molina lowers price of Bright Health’s California MA plans

Bright Health will get less money than expected for its California Medicare Advantage unit, after agreeing to lower its sale price from $510 million to $425 million.

By Emily Olsen • Updated Dec. 18, 2023

Healthcare costs will grow 7% next year, PwC finds

Providers are expected to seek rate increases from payers as they struggle with labor costs, while health plans will face pressure from increased pharmaceutical expenses.

By Emily Olsen • June 29, 2023

MA beneficiaries with chronic conditions have lower utilization, spending, industry-backed report finds

The Better Medicare Alliance-funded analysis compared beneficiaries with hypertension, hyperlipidemia and diabetes across MA and traditional Medicare and found that spending was “consistently higher” among FFS beneficiaries.

By Emily Olsen • June 28, 2023

Pfizer, citing safety concerns, scraps one of two obesity pill hopefuls

Liver enzyme elevations in early- and mid-stage testing have led the drugmaker to discontinue development of a medicine known as lotiglipron, dealing a blow to its hopes of catching rivals Lilly and Novo Nordisk. 

By Ben Fidler • June 26, 2023

North Carolina places Friday Health Plans into receivership as insurtech shuts down

A number of states have already moved to take control of the insurer, which announced it was winding down operations earlier this month.

By Emily Olsen • June 22, 2023

State Medicaid spending fell below pre-pandemic levels during continuous enrollment

An analysis by KFF found state spending on Medicaid fell during the COVID-19 pandemic even as enrollment soared. But spending will likely increase as the federal government begins to pare back its increased contribution.

By Emily Olsen • June 21, 2023

Insured adults give their health plans positive ratings, but most report problems

KFF found 81% of those surveyed gave their health plans an overall rating of “excellent” or “good.” But more than half also reported insurance problems like denied claims or network issues in the past year.

By Emily Olsen • June 20, 2023

Humana becomes second major payer to flag higher outpatient volumes in Q2

Pent-up demand for healthcare delayed during COVID-19 is making a reappearance, pressuring medical costs for health insurers that had a financial windfall during the pandemic.

By Rebecca Pifer Parduhn • June 16, 2023

MedPAC recommends return to lower telehealth payments

The group that advises Congress on Medicare policy also suggested more closely setting payment rates across outpatient facilities for some services, which hospital lobbyists oppose.

By Emily Olsen • June 16, 2023

Large, geographically diverse insurers see ‘very stable’ operating performance

Payers including UnitedHealth, Elevance Health, Cigna and Humana are benefiting from strong market share that aids them in negotiations with providers, Fitch Ratings found.

By Emily Olsen • June 14, 2023