One Medical partnering with Connecticut health system, but stock drags on high MLR

CEO Amir Dan Rubin told analysts in a call Wednesday that COVID-19 headwinds continue, including staffing shortages, a lag in return to care and reduced revenue from testing.

By Shannon Muchmore • Feb. 24, 2022

Humana agrees to board refresh in deal with activist hedge fund

It's the latest insurer facing pressure from an activist investor group, following a shakeup at Centene.

By Samantha Liss • Feb. 23, 2022

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

Ground ambulance costs continue to soar, study finds

More ambulance trips are billing for "advanced life support," denoting a higher level of care (and reimbursement). Private insurers' payments for those trips increased 56% between 2017 and 2020, Fair Health found.

By Rebecca Pifer • Feb. 22, 2022

FTC to vote on investigation into PBMs' drug pricing practices

The agency's commissioners will weigh Thursday whether to investigate PBMs and their relationship to drug prices and "practices that may disadvantage independent or specialty pharmacies," according to the meeting agenda.

By Samantha Liss • Feb. 17, 2022

FTC fails to get enough votes to launch study into PBM practices

Numerous pharmacists urged commissioners to probe the practices of PBMs, which they allege harm their independent pharmacies and threaten to drive them out of business.

By Samantha Liss • Feb. 17, 2022

Molina plans steep reduction in marketplace enrollment

The payer is expected to lose two-thirds of its marketplace enrollment by the end of the year, according to executives.

By Samantha Liss • Feb. 16, 2022

DOJ has until Feb. 27 to sue to block UnitedHealth's $8B Change acquisition

The companies said they would give the DOJ 10 days notice before completing the merger, during which the DOJ could launch a lawsuit to block it. On Feb. 17, UnitedHealth and Change gave the regulators that notice.

By Rebecca Pifer • Updated Feb. 22, 2022

Smaller rivals snap up Medicare Advantage members

MA startups were able to win market share during the most recent open enrollment period, threatening the market share of incumbents and suggesting more willingness to shop among U.S. seniors.

By Samantha Liss • Feb. 9, 2022

Boosters and test demand — coupled with lower COVID-19 treatment costs — drove CVS profit up 33% in Q4

People flocked to get booster shots as the omicron variant drove a sharp increase in testing, boosting revenue for CVS' drugstore segment. Meanwhile, its payer arm reported lower-than-expected COVID-19 treatment costs.

By Rebecca Pifer • Feb. 9, 2022

Jury trial gets underway in antitrust suit against Sutter Health

The California hospital system is accused of wielding its market power to drive up health insurance premiums for hundreds of thousands of consumers.

By Susan Kelly • Feb. 9, 2022

Congress poised to address mental health crisis — including fining payers for benefit inequities

"If we're going to respond to the behavioral health issues the pandemic has made worse ... that will take legislative action," Senate health committee Chairwoman Patty Murray, D-Wash., said.

By Rebecca Pifer • Feb. 4, 2022

Senators pinpoint MA oversight, cutting drug costs to address looming Medicare insolvency

"We should be addressing this in a more serious fashion than we are," Sen. Bill Cassidy, R-La., said.

By Rebecca Pifer • Feb. 3, 2022

Along with rate increase for MA plans, CMS pitches closer look at social determinants of health

Cowen analysts said the rate increase "should support another year of benefit enhancements & strong enrollment growth," and noted that in recent years the final rate has been higher than what was first proposed.

By Shannon Muchmore • Feb. 3, 2022

Anthem relies on flexible partner-not-build strategy in shift to value

It's a capital-efficient way to achieve growth without being pigeonholed into one approach and differs from the value-based blueprints of peers UnitedHealth and Humana, analysts said.

By Rebecca Pifer • Feb. 2, 2022

Humana looks to cut costs, reinvest $1B into Medicare business

Part of the plan includes "optimizing" the workforce. Executives didn't clarify whether that would include layoffs.

By Samantha Liss • Feb. 2, 2022

Payers, researchers warn CMS proposal could cut funds to insurers enrolling high-risk consumers

Insurers are flagging concerns about changes to a CMS model aimed at encouraging more healthy consumers to sign up for coverage, while new research finds the proposal could backfire.

By Susan Kelly • Jan. 31, 2022

Healthcare trends of 2022

U.S.-based digital health startups brought in almost $30 billion in 2021, nearly doubling the total investment from the prior year. Market watchers are wary on making forecasts that 2022 will break that record, but most are optimistic.

Jan. 31, 2022

Implementing value-based care to drive success for life sciences companies

Value-focused solutions can help life sciences groups make the switch to value-based contracting.

Jan. 31, 2022

ACA open enrollment period drove record number of sign-ups

Expanded tax credits through the American Rescue Plan made coverage more affordable and greater outreach efforts helped accelerate enrollment, health officials said.

By Hailey Mensik • Jan. 27, 2022

Anthem doubles profit to $1.1B, issues conservative 2022 guidance

Membership targets for the coming year, for one, "look a shade light," one analyst noted, though Anthem said it expects COVID-19 to cause less of a headwind in 2022 than in prior years.

By Rebecca Pifer • Jan. 26, 2022

Insurers falling seriously short in mental health, substance use disorder benefits, federal departments say

Though progress has been made, compliance with parity laws is still patchwork in the U.S., even as COVID-19 continues to throw disparities in health access into sharp relief.

By Rebecca Pifer • Jan. 25, 2022

4 key trends for payers and providers in 2022

The sectors face continued operational pressure as they head into a third year of the pandemic, including a tight labor market and shifts in payer mix.

By Samantha Liss • Jan. 21, 2022

How telehealth could be an equitable 'bridge to care' in a post-pandemic world

Much has been made of the technology's advantages, but it has its share of challenges when it comes to accessibility, experts said.

By Ryan Golden • Jan. 20, 2022

AHIP backs HHS in surprise billing suit, pushes back against provider claims

Relying on the qualifying payment amount, or median in-network rate, helps center the payment dispute, creating a starting point for when payers and providers may need to turn to a third-party arbiter, the lobby argued.

By Samantha Liss • Jan. 19, 2022

UnitedHealth reiterates MA growth expectations for 2022 as profits eclipse $4B

"Big picture, really positive," CEO Andrew Witty said about the fruitful MA market, despite dismal projections from some of UnitedHealth's peers about slowing enrollment.

By Rebecca Pifer • Jan. 19, 2022