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

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

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

Antitrust regulators aim to revamp merger guidelines, signaling threat to health sector deals

The news sparked headlines about an attempt by regulators to target big tech, but it could have serious implications for healthcare for years to come.

By Samantha Liss • Jan. 19, 2022

Medicare faces blowback over plan to limit coverage of Biogen's Alzheimer's drug

Biogen, along with allies in industry, plans to pressure Medicare to water down its policy, which limits coverage of Aduhelm and drugs like it to clinical trials.

By Jonathan Gardner , Jacob Bell • Jan. 14, 2022

Healthcare sharing ministry 'sham' faces suit for allegedly defrauding consumers in California

Aliera allegedly scammed thousands of people by collecting monthly payments but denying coverage of medical costs, a lawsuit claims.

By Samantha Liss • Jan. 13, 2022

Medicare proposes to limit coverage of Biogen Alzheimer's drug

The program will only cover Aduhelm, which the FDA controversially approved last June, for patients enrolled in clinical trials.

By Jonathan Gardner , Jacob Bell • Updated Jan. 11, 2022

Insurers will be required to cover 8 at-home COVID-19 tests per month

The Biden administration is incentivizing insurers to create programs that enable people to get tests from preferred pharmacies without paying upfront or needing to file a reimbursement claim.

By Nick Paul Taylor • Jan. 11, 2022

Becerra orders CMS to reassess Medicare premiums after Aduhelm cost cut

It's an unusual step for HHS, given the plan year has already begun, and follows Biogen slashing the price of its controversial Alzheimer's drug in half.

By Rebecca Pifer • Jan. 10, 2022

Centene reaches latest settlement over alleged PBM overcharging, agrees to pay New Hampshire $21M

The insurer has now settled with at least five states, paying out more than $236 million. It's possible more settlements are on the horizon, as Centene has set aside $1.1 billion for future payments.

By Samantha Liss • Jan. 10, 2022

Stakeholders urge Supreme Court to act fast on OSHA mandate

"We are asking for a stay before enforcement takes effect Monday," an attorney for the National Federation of Independent Businesses said.

By Ryan Golden • Updated Jan. 10, 2022

Humana slashes Medicare Advantage outlook, shares tumble

Competition for members was "very aggressive" as Humana's competitors came in with lower-priced plans and spent more on marketing to attract customers away, CEO Bruce Broussard said.

By Samantha Liss • Jan. 7, 2022

Biden admin proposes stricter network adequacy, marketing standards for MA plans

CMS is looking to hold Medicare Advantage plans to a higher standard as their rolls swell, targeting their networks, marketing practices and spending; while improving dual-eligible and Part D costs and patient input.

By Rebecca Pifer • Jan. 7, 2022

Hospitals' labor expenses rose again just before omicron arrival, report finds

Expenses outpaced revenue growth as hospitals continued grappling with nationwide staffing shortages in November, according to Kaufman Hall.

By Hailey Mensik • Jan. 5, 2022

After years of decline, drugmakers' price hikes may have bottomed out

Inflation in 2021 may have offered drugmakers a catalyst for taking slightly bigger increases on a list price basis. But rebates to insurers are still keeping net price rises lower.

By Jonathan Gardner • Jan. 5, 2022