UnitedHealth expects higher medical costs in Q2 as delayed care makes comeback

The insurer expects its medical loss ratio in the second quarter to reach or exceed its full-year target. UnitedHealth’s stock, along with that of other major Medicare payers, fell in Wednesday morning trading as a result.

By Rebecca Pifer Parduhn • June 14, 2023

Medicare Advantage overpayments could exceed $75B this year, study finds

The figure is almost triple prior estimates, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.

By Emily Olsen • June 14, 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

Expanded federal safety net during COVID led to improved health access for adults, report finds

Between 2019 and 2022, fewer adults reported taking on medical debt or forgoing medical care due to cost, according to the Robert Wood Johnson Foundation.

By Susanna Vogel • June 13, 2023

HHS offers aid amid Medicaid redetermination coverage losses

Secretary Xavier Becerra urged states to adopt new flexibilities to limit Medicaid churn, adding in a letter to state governors that he's "deeply concerned" about unnecessary coverage losses.

By Emily Olsen • June 13, 2023

Uber Health adds grocery, over-the-counter item delivery

The rideshare provider, which already offers non-emergency medical transportation and prescription delivery, has been expanding beyond medical transportation to coordinate care across multiple benefits.

By Rebecca Pifer Parduhn • June 13, 2023

CMS exploring models centered on social health factors

Regulators said they’re trying to work around restrictions regarding what groups Medicare is allowed to pay as they look to address social determinants of health.

By Rebecca Pifer Parduhn • June 9, 2023

Insurers report stable performance amid industry headwinds, but cost pressures loom

Provider cost pressures are weighing on the nation's largest insurers, with contract negotiations possibly forcing premiums higher over the next few years, according to Fitch Ratings.

By Sydney Halleman • June 7, 2023

Merck sues to stop Medicare negotiation of drug prices

The drugmaker’s lawsuit claims the new pricing powers granted by the Inflation Reduction Act are unconstitutional and “tantamount to extortion.”

By Christopher Newman • June 6, 2023

Friday Health Plans to shut down as state regulators step in

In a statement, the insurer said it was “unable to scale our financial infrastructure to match the pace of our growth and secure the additional capital required to run our business.”

By Emily Olsen • June 5, 2023

UnitedHealth rolls back gastroenterology prior authorization plan amid backlash

The American Hospital Association said it thinks the new advance notification process is a better approach than prior authorization, but other medical groups took a harsher stance against the refocused policy.

By Rebecca Pifer Parduhn • June 2, 2023

Over half a million disenrolled amid Medicaid redeterminations so far

A KFF analysis of 11 states found many of the people who have already been removed from the Medicaid program were disenrolled for procedural reasons.

By Emily Olsen • June 1, 2023

Medicare keeps limits on Alzheimer’s drug coverage, but loosens policy

The agency will reimburse Alzheimer’s treatments if they receive full FDA approval, but plans to still require data collection via a patient registry.

By Christopher Newman • June 1, 2023

Healthcare costs top $31,000 for family of 4 in 2023

After declining briefly in 2020, family healthcare costs are rising as the industry faces an uncertain macroeconomic environment.

By Emily Olsen • June 1, 2023

Members’ satisfaction with commercial health plans declines

A J.D. Power study found overall satisfaction with commercial health plans fell, with sicker members less likely to receive outreach and care coordination.

By Emily Olsen • May 31, 2023

Kaiser pledges $10M to safety-net hospital to stem ‘unprecedented financial challenges’

Denver Health — the largest provider of care for uninsured people in the city — has struggled with rising costs and a surge in sicker patients.

By Sydney Halleman • May 31, 2023

Postpartum people could lose coverage amid Medicaid redeterminations

People in some states could lose postpartum coverage 60 days after giving birth, even though health risks from pregnancy can continue for months, according to a new report from KFF.

By Emily Olsen • May 30, 2023

Healthcare provisions of the debt limit deal: COVID-19 funding clawbacks, no Medicaid work requirements

Congressional Republicans and the White House reached a deal over the weekend to raise the debt ceiling that includes healthcare policy wins for both sides of the aisle.

By Rebecca Pifer Parduhn • May 30, 2023

CVS could lose up to $1B next year from MA star ratings drop

Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed.

By Rebecca Pifer Parduhn • May 26, 2023

Two-thirds of Medicaid enrollees unaware of redeterminations, survey finds

The KFF survey found many enrollees weren’t sure whether states are now allowed to remove people from the program, and 27% wouldn’t know where to look for coverage if they were ineligible for Medicaid.

By Emily Olsen • May 25, 2023

AHIP chief executive to step down in October

Matt Eyles will depart after serving nearly five years as CEO of AHIP. The organization is launching a nationwide search for his replacement.

By Sydney Halleman • May 25, 2023

US projected to hit record-low uninsurance rate this year

But as federal aid expires, lower-income Americans — who saw the largest insurance gains during the pandemic — will likely be affected the most, according to experts.

By Rebecca Pifer Parduhn • May 24, 2023

Health tech startup Florence buys Zipnosis from Bright Health

Bright Health, which is exiting the insurance business, purchased telehealth company Zipnosis in 2021.

By Emily Olsen • May 24, 2023

Biden administration aims to increase Medicaid drug transparency

The notice of proposed rulemaking recommends that the CMS and states get a drug price verification survey tool and negotiate for expensive drugs under Medicaid.

By Brian T. Horowitz • May 24, 2023

House lawmakers, PBM lobby spar over committee hearing

At the latest congressional inquiry into pharmacy benefit managers, lawmakers argued the middlemen profit at the expense of patients and taxpayers.

By Rebecca Pifer Parduhn • May 24, 2023

What 3 key congressional hearings last week mean for the industry

Political will seems to be rising to address drivers of growing medical costs and poor access to care, according to lawmaker comments on the Hill.

By Sydney Halleman , Rebecca Pifer Parduhn • May 19, 2023