Payer: Page 46
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Membership growth drives CVS profit up, despite less help from testing, vaccinations
Business trends normalized in the first quarter, with less of a boost from COVID-19 tailwinds for the Rhode Island-based company.
By Rebecca Pifer • May 4, 2022 -
Insurers may be padding Medicaid physician networks, study finds
Some doctors listed in managed care provider network directories didn't file any Medicaid claims over the course of a year, according to new research published in Health Affairs.
By Susan Kelly • May 3, 2022 -
Explore the Trendlineâž”
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 -
ACA-related coverage enrollment tops record at nearly 36M
The expansion of health coverage to more Americans reflects pandemic-related policy efforts.
By Susan Kelly • May 2, 2022 -
Surprise Billing
Air ambulance provider latest to sue over surprise billing ban
The central issue of the new lawsuit is the guidance the federal government has provided to third-party arbiters.
By Samantha Liss • May 2, 2022 -
Joe Raedle via Getty Images
Biden admin suspends Georgia plan to let private sector run ACA marketplace
CMS Administrator Chiquita Brooks-LaSure said the controversial plan would provide coverage to fewer people and no longer complies with federal law and other policies.
By Rebecca Pifer • May 2, 2022 -
Medicare Advantage plans denied some members needed care, OIG finds
The report calls for improved oversight of MA and urges the CMS to update audit protocols and issue new guidance on medical necessity reviews performed by the plans.
By Samantha Liss • April 29, 2022 -
Stefani Reynolds / Stringer via Getty Images
'Very false and misleading' criticisms over direct contracting stoked model controversy, stakeholders say
Political ire around direct contracting that came to a head earlier this year was rooted in a "real lack of understanding," one CEO of a physician group said at NAACOS' spring conference.
By Rebecca Pifer • April 29, 2022 -
Win McNamee via Getty Images
Molina's first-quarter COVID-19 costs reached highest peak since pandemic's start, CEO says
Still, those costs were almost entirely offset by members cutting back on healthcare visits, a common trend throughout the pandemic, CEO Joe Zubretsky said Thursday.
By Samantha Liss • April 28, 2022 -
Samantha Liss/Healthcare Dive
Centene adds 2 executives to office of the CEO
The now five-person office will assist CEO Sarah London in setting policy and executing the company's enterprise agenda, London announced Tuesday on a call with investors.
By Samantha Liss • April 27, 2022 -
Getty Images
Centene addresses 'challenges' in California's Medi-Cal Rx launch
The payer's CEO is addressing concerns around the implementation of the state's new Medicaid prescription drug program, following reports of members struggling to get access and approvals to needed medications.
By Samantha Liss • April 27, 2022 -
Getty Images
Employers are reevaluating health benefits amid tight labor market, survey finds
Improving affordability, providing virtual care and boosting mental health offerings will be top priorities for U.S. employers over the next two years, according to a Willis Towers Watson report.
By Susan Kelly • April 27, 2022 -
CrackerClips via Getty Images
Biden admin drops challenge to Texas Medicaid waiver
The state's main hospital lobby called the waiver's survival, which was also praised by Republicans late last week, a relief.
By Rebecca Pifer • April 25, 2022 -
Courtesy of Humana
Humana to sell majority stake in Kindred hospice arm to PE firm for $2.8B
The divestiture doesn't come as a surprise, as the payer expressed its intent to sell a majority stake in Kindred's hospice and community care arms when it finished snapping up the homecare company last year.
By Rebecca Pifer • April 22, 2022 -
Elizabeth Regan/Healthcare Dive
Drug price hikes moderate as rebates rise, report finds
List prices for branded medicines rose by nearly 5% last year, according to Iqvia, a figure that fell to 1% after accounting for rebates and discounts.
By Ned Pagliarulo • April 21, 2022 -
Stefan Zaklin via Getty Images
House Democrats urge Biden admin to curtail short-term plan access
The HHS is facing increasing pressure to limit enrollment in the cheap yet skimpy plans, which aren't required to comply with consumer protections under the Affordable Care Act.
By Rebecca Pifer • April 20, 2022 -
Julia Rendleman via Getty Images
Traveling Kaiser members get access to Cigna providers under new deal
Under the five-year agreement, Kaiser members will be responsible for the cost-sharing within their plan, and not have to pay out-of-network rates for visiting Cigna providers outside of the eight states covered by Kaiser.
By Rebecca Pifer • April 20, 2022 -
Surprise Billing
Surprise billing arbitration portal opens to payers, providers after delay
As a last resort, the No Surprises Act allows payers and providers to resolve payment disputes using arbitration. The online site that initiates the process is now open.
By Samantha Liss • April 19, 2022 -
Getty Images
Hospitals massively mark up cancer therapy prices for private insurance patients, JAMA study finds
Researchers also found that most National Cancer Institute-designated facilities did not publicly disclose payer-specific prices for cancer therapies as required by federal price transparency regulations.
By Hailey Mensik • April 19, 2022 -
End of Medicaid continuous coverage may leave millions of children uninsured, analysis finds
Children are at highest risk in Texas, Florida and Georgia when states resume checking Medicaid eligibility after the public health emergency expires, Georgetown University researchers found.
By Susan Kelly • April 19, 2022 -
Bright Health exits 6 states amid financial, operational woes
Bright, which went public in June last year, wants to refocus on growth in markets where it can have a bigger impact. The seven-year-old startup lost almost $1.2 billion in 2021.
By Rebecca Pifer • April 18, 2022 -
UnitedHealth expects to 'successfully overcome' DOJ challenge to Change acquisition
The company is bullish on completing its controversial acquisition of data analytics firm Change Healthcare, despite legal action from the Department of Justice to block the deal.
By Rebecca Pifer • April 14, 2022 -
ACA marketplace premiums decline for third consecutive year, Urban Institute finds
The marketplace is bucking the trend of sustained premium increases for job-based coverage, which provides insurance to a majority of nonelderly Americans.
By Samantha Liss • April 13, 2022 -
Medicare finalizes policy limiting coverage of Biogen Alzheimer's drug
Treatment with Aduhelm would only be covered for patients enrolled in a clinical trial under the policy, which largely follows a draft proposal released in January.
By Jonathan Gardner • Updated April 7, 2022 -
Samantha Liss / Industry Dive/Healthcare Dive
Centene's former longtime leader Michael Neidorff dies
Neidorff transformed the St. Louis-based insurer into a formidable player in the healthcare sector during his 26 years at the helm.
By Samantha Liss • April 8, 2022 -
Anna Moneymaker via Getty Images
Biden proposes rule to fix ACA's 'family glitch'
The new regulation could help an estimated 200,000 uninsured people in the U.S. gain coverage, while 1 million could benefit from less expensive plans.
By Susan Kelly • April 6, 2022
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