Payer: Page 45
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Deep DiveDespite rosier trust fund outlook, time running out to stabilize Medicare funding, researchers warn
Though it’s tempting to interpret the recent Medicare trustees report as good news, academics are arguing lawmakers can’t wait until hospital trust fund insolvency is imminent before taking action to bolster the program.
By Rebecca Pifer • June 13, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC launches investigation into PBMs; CVS, UnitedHealth, Cigna and more hit with requests for data
Pharmacy groups cheered the news, which reversed a vote earlier this year by FTC commissioners not to investigate PBMs' pricing and contractual practices.
By Rebecca Pifer • June 7, 2022 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
Permission granted by Pear Therapeutics
Pear sets out payer strategy as it seeks to quadruple prescriptions of digital therapeutics
Pear shared real-world data that linked its digital therapeutic for substance use disorders to an estimated $3,591 reduction in per-patient costs.
By Nick Paul Taylor • June 7, 2022 -
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Payers to return $1B to enrollees after record years of rebates, KFF says
The amount reflects the third-straight year of large insurer rebates as payers experienced high profits from the COVID-19 pandemic.
By Sydney Halleman • June 3, 2022 -
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Trustees' report shows additional breathing room for Medicare solvency, though concerns remain
Stronger-than-expected economic recovery from COVID-19 pushed back Medicare's go-broke date by two years, though budget hawks are warning the sunnier outlook might rely on outdated assumptions.
By Rebecca Pifer • June 3, 2022 -
PBM practices are keeping consumers from generics savings, white paper finds
Consumers are overpaying for generic drug prescriptions by as much as 20% due to pharmacy benefit manager practices like copay clawbacks and spread pricing, researchers found.
By Rebecca Pifer • June 1, 2022 -
Permission granted by Biogen
Medicare premiums will remain unchanged after Aduhelm price cut spurs review
The HHS Secretary had hoped premiums could be cut for seniors sooner rather than later but there are "legal and operational hurdles" to changing premiums midyear, according to a statement released Friday.
By Samantha Liss • May 31, 2022 -
Rollback of pandemic protections to test Medicaid managed care organizations
At question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.
By Samantha Liss • May 26, 2022 -
Permission granted by Clover Health
Clover Health appoints Scott Leffler as CFO following role turnover
Leffler joins the nine-state insurtech from sterilization and lab services provider Sotera, where he was CFO for five years.
By Rebecca Pifer • May 26, 2022 -
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Study: Pre-deductible HSA coverage of chronic condition meds won't jack up premiums
A 2019 IRS notice expanded the list of medications and health services that some plans may cover pre-deductible, including those used to treat chronic conditions.
By Ryan Golden • May 25, 2022 -
North Carolina Republicans draft Medicaid expansion bill
The proposal, which signals growing support for expansion among state lawmakers after years of opposition, would add 600,000 low-income adults to the safety net insurance program.
By Susan Kelly • May 25, 2022 -
AHA urges DOJ to probe Medicare Advantage plans that deny care
The hospital lobby is pushing the Justice Department to punish Medicare Advantage organizations that routinely deny coverage to beneficiaries.
By Susan Kelly • May 23, 2022 -
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Sponsored by ProviderTrustTravel nurses: a challenging population for credentialing and monitoring
Travel nursing continues to rise – how are you monitoring license verifications across state lines?
May 23, 2022 -
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Google hires former FDA digital health officer to global strategy post
In his new role, Bakul Patel will help Google build a unified digital health and regulatory strategy.
By Samantha Liss • May 19, 2022 -
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Hospitals charge employer health plans more than 2 times what they charge Medicare for same services
Rand researchers also found wide price variations across states. Florida, West Virginia and South Carolina had relative prices at or above 310% of Medicare prices, according to the report.
By Hailey Mensik • May 18, 2022 -
Courtesy of Oscar Health
Oscar faces shareholder lawsuit alleging it misled investors
The insurer is accused of failing to disclose the potential negative impact of the COVID-19 pandemic on its business before its March 2021 IPO.
By Susan Kelly • May 17, 2022 -
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Humana expanding primary care clinics through second joint venture with PE firm
The payer plans to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 through the latest deal.
By Hailey Mensik • May 17, 2022 -
Insurers seek steep marketplace premium hikes in Vermont
Proposed average increases on individual and family plans would buck the national trend of declining ACA exchange premiums. The increases would reach 17% for MVP Health Care and 12% for Blue Cross Blue Shield.
By Susan Kelly • May 16, 2022 -
Courtesy of Oscar Health
Oscar Health withdraws from 2 states
Leaving Arkansas and Colorado won't have a material effect on the company's income, and should reduce the insurtech's overhead in areas like compliance work and statutory reporting, executives said.
By Rebecca Pifer • May 11, 2022 -
Insurers saw profits rise in Q1 as cost increases weighed on hospitals
The results spurred payers to paint an improved financial outlook for the full year compared to earlier estimates for 2022.
By Samantha Liss • May 9, 2022 -
Yujin Kim/Healthcare Dive
Cigna Q1 profit increased on lower COVID-19 costs as patients were less ill
Cigna executives said medical expenses in the quarter were better than they estimated due to lower COVID-19 testing and treatment costs.
By Samantha Liss • May 6, 2022 -
Permission granted by Biogen
Biogen, having scrapped Aduhelm, tries to convince investors of turnaround plan
Though executives claimed that inking deals and de-risking research programs are priorities, analysts questioned whether any meaningful strategic changes will occur in the near term.
By Jacob Bell • May 5, 2022 -
Samantha Liss/Healthcare Dive
Centene to sell 2 pharmacy businesses as it advances portfolio review
The news builds on the payer's plan to sell off non-core assets as it looks to sharpen its focus on its main business.
By Samantha Liss • May 5, 2022 -
Megan Quinn/Healthcare Dive
Hospital, payer, IT groups urge Congress to overturn ban on unique patient identifier
Industry groups are ratcheting up the pressure on Congress to nix a decadesold ban on using federal funding to create a UPI. Subcommittees, meanwhile, are continuing hearings for 2023 appropriations bills.
By Rebecca Pifer • May 5, 2022 -
Permission granted by Biogen
Biogen CEO to step down as company pulls back from Alzheimer's drug
Michel Vounatsos, Biogen's CEO since 2017, will be replaced as the company "substantially" eliminates the commercial workforce around Aduhelm, which has generated paltry sales in the face of resistance from insurers and doctors.
By Jacob Bell • Updated May 3, 2022
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