Payer: Page 47
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Courtesy of Gilead Sciences
CAR-T treatment moves earlier as FDA widens approval of Gilead's Yescarta
There are some obstacles to use. Yescarta is expensive, priced by Gilead at $373,000 per patient. Treatment is now widely covered by insurance, but the cost can still present hurdles for patients, depending on their coverage plans.
By Ned Pagliarulo • April 6, 2022 -
Permission granted by JM Electrical
Facing opposition, Mass General Brigham pulls back surgery center plans
Although the system has withdrawn a proposal for three suburban surgery centers, it did secure recommendations for conditional approval for two other large-scale projects.
By Samantha Liss • April 5, 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 -
Medicare Advantage plans will see 8.5% revenue bump in 2023
CMS is not changing the risk adjustment calculation, which is meant to compensate plans for treating sicker patients. That's despite calls for an overhaul in the wake of allegations of abuse of the system.
By Shannon Muchmore • April 5, 2022 -
Mario Tama via Getty Images
Hospital E/M visit charges continued to rise in 2020, Fair Health finds
Meanwhile, the percentage of claims for telehealth shot up from just 0.22% of all claims in 2019 to about 15% in 2020, as COVID-19 restrictions set in and patients worried of virus transmission.
By Shannon Muchmore • March 30, 2022 -
Samantha Liss/Healthcare Dive
Centene hit with $9M fine in Florida
Florida is freezing enrollment in Centene's plans, according to a March 17 letter sent to the CEO of the Florida division, the Sunshine State Health Plan.
By Samantha Liss • March 30, 2022 -
UnitedHealth to buy home health business LHC for $5.4B
A growing number of health insurers, private equity companies and hospitals are snapping up home health and hospice practices, with hopes for a substantial ROI.
By Rebecca Pifer • March 30, 2022 -
Diego Camargo/Healthcare Dive
Two years into the COVID-19 pandemic
Hospitals overhauled their operations in COVID-19's early days. Now, two years into the pandemic, they are looking ahead at the future of their business, including revenue diversification and workforce stability.
March 29, 2022 -
Record 14.5M Americans signed up for ACA coverage this year
But the generous subsidies that contributed to the increase in enrollment are temporary and set to expire at the end of the year absent congressional action.
By Rebecca Pifer • March 24, 2022 -
Permission granted by Centene
Centene appoints London as CEO, succeeding longtime leader Neidorff
Sarah London specializes in data and technology and has quickly ascended the ranks at Centene, most recently rising to vice chairperson.
By Samantha Liss • March 23, 2022 -
Mario Tama via Getty Images
Labor union health fund targets hospital prices, looks to form purchasing coalition
If successful, the coalition would bring together New York City's largest public employee union and the United Federation of Teachers. Together the group would represent about 540,000 people.
By Samantha Liss • March 22, 2022 -
Rebecca Pifer/Healthcare Dive
HIMSS22Payer-to-payer data exchange rule to be published 'soon,' CMS head says at #HIMSS22
CMS hasn't been enforcing stipulations that payers share patient data with competitors set out in regulations finalized two years ago. But that could change soon with a new rule.
By Rebecca Pifer • March 15, 2022 -
Permission granted by Biogen
Biogen and its partner rework terms of Aduhelm deal amid slow sales
Instead of sharing global profits and losses, Eisai will receive royalties tied to net sales of the Alzheimer's drug. Biogen, meanwhile, said the amended deal should make it easier to "address market developments."
By Jacob Bell • March 15, 2022 -
Sutter Health defeats antitrust challenge in jury trial
The federal jury in a class action suit rejected allegations that the California hospital system drove up healthcare costs in its markets through anti-competitive practices.
By Susan Kelly • March 14, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
Grassley pushes for PBM probe
The senator wants FTC commissioners to come up with a more targeted focus for the study and suggested narrowing a review to the impact on consumers and their out-of-pocket costs.
By Samantha Liss • March 14, 2022 -
Anthem plans to change name to Elevance
It's the second name change for Anthem in the past decade. Prior to 2014, the company was known as WellPoint.
By Shannon Muchmore • March 10, 2022 -
Medical groups say prior authorization burdens persisted during pandemic
A new survey of doctor practices from the Medical Group Management Association found 98% of respondents wrestled with an increased or steady level of prior authorization requirements over the past year.
By Susan Kelly • March 8, 2022 -
L.A. Care fined $55M after members faced barriers to timely care
The fine is reportedly the largest in California history following an investigation that revealed serious systemic failures.
By Samantha Liss • March 7, 2022 -
Getty Images
Civica targets insulin in effort to produce cheaper drugs
The nonprofit group announced ambitious plans to begin offering insulin at prices no higher than $30 per vial by early 2024.
By Kristin Jensen • March 4, 2022 -
Humana adds Cerner's Feinberg to board amid activist pressure
Longtime Humana board member Marissa Peterson will not stand for reelection at the upcoming shareholder meeting, according to a proxy statement.
By Samantha Liss • Updated March 9, 2022 -
Primary care physician turnover costs payers almost $1B every year, study finds
Disruptions in care continuity when primary care providers leave their practices was a costly issue even before the pandemic, according to the American Medical Association.
By Hailey Mensik • March 3, 2022 -
Win McNamee / Staff via Getty Images
Biden discusses drug prices, mental health services in annual address
The president also announced a "test to treat" program that would allow people to receive a COVID-19 test at a pharmacy and immediately receive free antiviral pills, such as Pfizer's Paxlovid or Merck's molnupiravir.
By Shannon Muchmore • March 2, 2022 -
Alex Wong via Getty Images
CMS redesigns controversial Medicare direct contracting model
The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders.
By Rebecca Pifer • Feb. 28, 2022 -
DOJ moves forward with suit to block UnitedHealth's acquisition of Change
The lawsuit alleges that if UnitedHealth acquired Change, the payer would be able to gain a competitive advantage by seeing "very competitively sensitive" data from other insurers.
By Shannon Muchmore • Feb. 25, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC seeks public comments on pharmacy benefit managers' impact on patients, pharmacies
After a failed bid to launch a formal inquiry into PBMs, the FTC now says it wants to collect comments from the public to study a wide array of PBM practices.
By Samantha Liss • Feb. 25, 2022 -
Courtesy of One Medical
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
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