Tomorrow’s healthcare industry leaders will be masters of agility and innovation — a product mindset will show them the way

Though healthcare hasn’t always been considered a hotbed of innovation; new market pressures are pushing payer and provider organizations to become more flexible and agile than ever before.

Nov. 7, 2022

Cigna faces questions about M&A strategy amid ‘arms race’ for deals

One analyst asked whether not pursuing deals will pose a disadvantage in future years. CEO David Cordani said he is open to M&A but does not think acquisitions are a “silver bullet.”

By Samantha Liss • Nov. 3, 2022

CVS agrees to pay $5B to resolve opioid-related lawsuits

Walgreens and Walmart also have reportedly reached deals. If they become final, it could end much of the yearslong litigation over the pharmacy companies’ role in the opioid epidemic.

By Rebecca Pifer Parduhn • Nov. 2, 2022

CMS to ease Medicare ACOs into risk models in bid to boost participation

Beginning in January 2024, ACOs that don’t have experience with performance-based risk will be able to stay in a one-sided risk arrangement for up to seven years before transitioning to two-sided risk.

By Shannon Muchmore • Nov. 2, 2022

CMS finalizes requirements for rural emergency hospital designation

The conditions of participation include maintaining an average length of stay of no more than 24 hours and having emergency care available 24 hours a day, seven days a week.

By Shannon Muchmore • Nov. 2, 2022

Humana expects Medicare Advantage enrollment to grow almost 9% in 2023

Executives said better benefits are attracting more members. For certain plans, Humana members have an allowance for healthy foods, over the counter items, transportation, health supplies, rent and utilities.

By Samantha Liss • Nov. 2, 2022

Cigna partners with in-home primary care provider Heal

The provider, which focuses on care for seniors, is collaborating with Cigna to offer house calls and remote monitoring to Medicare Advantage customers in four states.

By Susan Kelly • Nov. 1, 2022

Seniors to see reduced delays in Medicare coverage under new Biden admin policies

Under the changes, traditional Medicare coverage will kick in the month immediately after enrolling.

By Samantha Liss • Oct. 31, 2022

UnitedHealthcare latest payer to expand ACA reach with 4 new states for 2023

The payer has been steadily ratcheting up its presence on the Affordable Care Act exchanges after dramatically reducing its footprint in 2017.

By Rebecca Pifer Parduhn • Oct. 28, 2022

Molina’s contract wins will have ‘profound impact’ on company, CEO says

The string of Medicaid contracts amount to $5.8 billion in additional annual premium revenue, according to CEO Joe Zubretsky.

By Samantha Liss • Oct. 27, 2022

Express Scripts lands its largest client in Centene

Cigna’s Express Scripts will manage more than $35 billion in annual prescription drug spend for Centene, which will soon be its No. 1 client.

By Samantha Liss • Oct. 26, 2022

Nearly half of consumers are in debt due to medical bills, survey finds

Many are struggling to afford their private health insurance and are unprepared for a medical emergency, a poll conducted for telehealth provider Babylon showed.

By Susan Kelly • Oct. 26, 2022

10-week Kaiser strike ends with deal aimed at improving mental health access

About 2,000 mental health clinicians at the system’s facilities in Northern California walked off the job in protest of what they said were prolonged wait times and unmanageable work loads.

By Hailey Mensik • Oct. 25, 2022

Cigna’s Express Scripts wins Centene’s $35B prescription drug contract

The PBM contract is one of the largest to change hands recently, one analyst said. Centene will drop CVS Caremark in 2024.

By Samantha Liss • Oct. 25, 2022

Leveraging AI to benefit the healthcare ecosystem for providers, payers and members

Research revealed leveraging AI will benefit the entire healthcare ecosystem for payers.  

By Bevey Miner, HIT Strategist, Consensus Cloud Solutions • Oct. 24, 2022

Elevance says it’s now the largest US insurer, beating out UnitedHealthcare. Analysts say it’s not that simple.

CEO Gail Boudreaux said the company has solidified its spot as the top insurer, but some analysts aren’t ready to crown the company with that title — yet.

By Samantha Liss • Oct. 21, 2022

Crossover Health in talks with multiple major insurers to offer capitated primary care

Crossover has been working on extending its business model to payer clients for several years now, and will have more news to share by the end of the year.

By Rebecca Pifer Parduhn • Oct. 21, 2022

Molina whistleblower case moves forward after SCOTUS declines to hear challenge

A former contractor alleged the payer billed and received payment from the Illinois Medicaid program for services it did not provide.

By Hailey Mensik • Oct. 19, 2022

Elevance Health records $1.6B profit as it braces for recession

CEO Gail Boudreaux attempted to temper concerns about the impact a recession may have on the company during a Q3 earnings call Wednesday.

By Samantha Liss • Oct. 19, 2022

Falling MA star ratings dog payers’ future earnings

Volatility in MA stars for the 2023 plan year is raising questions around the earnings outlooks issued by payers.

By Rebecca Pifer Parduhn • Oct. 18, 2022

DOJ sues Cigna for exaggerating patient illnesses

The insurer paid vendors to conduct in-home visits with its members, then pressured the vendors to record high-value diagnoses that would lead to higher payments for Cigna, the DOJ alleges.

By Samantha Liss • Oct. 18, 2022

HHS approves Medicaid housing intervention program in Arizona

It’s the latest demonstration approval from the agency, following others in Oregon and Massachusetts targeted at expanding access to coverage and addressing nutrition and housing needs.

By Hailey Mensik • Oct. 17, 2022

States need help to enforce mental health parity laws, report finds

Researchers from Georgetown University advocate for more federal support to remove insurance-related obstacles to treatment.

By Susan Kelly • Oct. 17, 2022

Healthcare payments: Remedy these 3 compliance risks

Explore potential consequences and remedies for 3 compliance risks in the healthcare payments space.

Oct. 17, 2022

Price transparency data provides new visibility into real rates paid to providers

Payers can use the data to gain insights regarding the rates hospitals have negotiated with other payers, which potentially can be used during contract negotiations, BRG analysts argue.

By JoAnna Younts and Konstantin Gorelik • Oct. 14, 2022