Senate scrutinizes MA payment denials, including use of algorithms

“Insurers are in effect denying Americans necessary care in order to fatten and pad their bottom lines, and that phenomenon is unacceptable,” Sen. Richard Blumenthal, D-Conn., said at a subcommittee hearing.

By Rebecca Pifer Parduhn • May 18, 2023

On heels of Amgen lawsuit, FTC broadens investigation of PBMs

The regulator is probing the business practices of two more drug purchasing organizations, deepening an investigation that began last year.

By Kristin Jensen • May 18, 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

House committee centers blame on PBMs for rising healthcare costs

Conversation about pharmacy benefit management consolidation dominated the hearing, with lawmakers pointing to the middlemen as drivers of high health costs.

By Sydney Halleman • May 18, 2023

Uninsured rate fell 18% during pandemic, CDC finds

The findings reflect government subsidies aimed at boosting healthcare access during the pandemic, and requirements that states keep Medicaid beneficiaries on their rolls during the public health emergency.

By Brian T. Horowitz • May 17, 2023

Appellate court pauses ruling blocking ACA preventive care mandate

The temporary administrative stay, which now legally requires health plans to provide preventive care for over 150 million Americans, applies while an appeal of the March case is considered by the court.

By Sydney Halleman • May 16, 2023

Envision Healthcare files for Chapter 11 bankruptcy

The physician staffing firm suffered from declining profits amid hurdles from the COVID-19 pandemic, prolonged legal battles with health insurers over reimbursement and regulatory crackdowns on surprise billing.

By Sydney Halleman • May 15, 2023

Rethinking the area deprivation index: a call for more effective measures to promote health equity

Srilekha Palle, visiting fellow at the Independent Women’s Forum, argues that a key health equity indicator used by the Biden administration has significant limitations that could exclude many underserved communities.

By Srilekha Palle • May 12, 2023

Bright Health affirms intention to sell California MA plans as it reports Q1 results

By selling its Brand New Day and Central Health MA plans, Bright Health, which would no longer be in the insurance business following the sale, intends to focus on its consumer care products, CFO Cathy Smith said.

By Brian T. Horowitz • May 10, 2023

Oscar Health will exit from California

The insurer plans to exit the state this year after consistently recording medical loss ratios over 100%, executives said on an earnings call.

By Sydney Halleman • May 10, 2023

Here’s what will change when the COVID public health emergency ends

Vaccines, which have been crucial to curbing the threat of the virus, will remain free for the vast majority of people in the U.S., but over-the-counter tests will no longer be covered for most.

By Shannon Muchmore • May 10, 2023

Cigna raises full-year guidance on $46.5B in Q1 revenue

CFO Brian Evanko said that, while Cigna is “not yet seeing signs of economic pressure,” it expects higher levels of overall disenrollment in the back half of the year.

By Shannon Muchmore • May 5, 2023

Bright Health gets new CFO

Bright’s current SVP of finance Jay Matushak is stepping up after the current CFO elected to leave the post to pursue a new opportunity, the company said Wednesday.

By Rebecca Pifer Parduhn • May 4, 2023

Half of all Medicare beneficiaries are now enrolled in MA plans

Enrollment in MA plans has steadily increased since 2007, when one in five Medicare beneficiaries were enrolled in a private plan.

By Brian T. Horowitz • May 3, 2023

CVS lowers 2023 earnings outlook on Oak Street, Signify deal costs

The company’s recent big-ticket acquisitions are taking a toll on its financial outlook, though management told investors Wednesday the company still expects to reach its prior earnings targets for 2024 and 2025.

By Rebecca Pifer Parduhn • May 3, 2023

Envision wins $91M in arbitration against UnitedHealthcare

The arbitration panel found UnitedHealthcare “unilaterally reduced reimbursement to Envision clinicians,” in violation of its in-network agreement.

By Sydney Halleman • May 3, 2023

CVS closes $10.6B Oak Street Health buy

With the deal’s completion, CVS adds a multi-state chain of medical clinics for seniors to its primary care roster.

By Rebecca Pifer Parduhn • May 2, 2023

Bright Health explores sale of California MA business

The move, if completed, would mean the end of the company as a health insurer.

By Rebecca Pifer Parduhn • May 1, 2023

CMS targets Medicaid payment transparency, wait times in new proposed rules

The agency wants to create maximum waiting times for certain appointments in addition to requiring stronger quality monitoring and reporting standards for Medicaid and CHIP managed care plans.

By Sydney Halleman • April 28, 2023

Lawmakers show bipartisan support for site-neutral payments

Political will appears to be rising to equalize Medicare payments to hospitals and doctor’s offices for certain low-acuity services, according to lawmaker comments during a Wednesday hearing.

By Rebecca Pifer Parduhn • April 27, 2023

Molina expects half of Medicaid enrollees gained during COVID to lose eligibility due to redeterminations

Redeterminations, which began earlier this month, are not expected to result in a “significant margin impact,” Molina’s CEO said, as the payer raised its full-year guidance.

By Sydney Halleman • April 27, 2023

Kaiser names new chief digital officer

Nari Gopala has previously served in leadership positions at Amazon Web Services, Daybreak Game Company and Sony Online Entertainment.

By Shannon Muchmore • April 26, 2023

Humana boosts 2023 expectations for Medicare Advantage growth

The insurer reported favorable MA inpatient utilization as COVID-19 claims decreased in the first quarter.

By Shannon Muchmore • April 26, 2023

Centene lowers 2024 earnings guidance as Medicaid redeterminations roll out

The payer beat Wall Street expectations in the first quarter on both earnings and revenue, which reached $39 billion.

By Shannon Muchmore • April 25, 2023

AHIP’s new ad spot targets pharma over drug costs as Congress scrutinizes PBMs

The marketing push comes as lawmakers take a harder look at pharmacy benefit managers, drug purchasing middlemen that are often owned by health insurance companies.

By Rebecca Pifer Parduhn • April 25, 2023

Clover cuts 10% of workforce, moves core operations to UST HealthProof

Carrying out the restructuring will result in a charge of about $7 million to $9 million in the first half of 2023, the company reported.

By Brian T. Horowitz • April 19, 2023