Elevance sees revenue boost as it focuses on Medicaid redeterminations

The payer said it was pleased with the recent CMS decision to phase in risk adjustment changes to the Medicare Advantage program that would allow it to “smooth the impact” to beneficiaries and providers.

By Shannon Muchmore • April 19, 2023

CMS walks back limits on non-standardized plan options, finalizes marketplace standards

The final rule comes as a record 16.3 million Americans, spurred by COVID-19 incentives, signed up for ACA marketplace plans during 2023 open enrollment.

By Sydney Halleman • April 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

CVS Health names new president of Aetna

Brian Kane, who previously worked as a consultant and was CFO at Humana, will replace Daniel Finke, who is stepping down.

By Susan Kelly • April 18, 2023

UnitedHealth notches record revenue in first quarter

UnitedHealth’s growth, which resulted in a profit of $5.8 billion in the quarter, was “stronger than normal,” one analyst said.

By Rebecca Pifer Parduhn • April 14, 2023

Care access, affordability impeding long COVID patients, study finds

Survey respondents had difficulty finding clinicians and health insurance and struggled to keep up with family medical bills in the previous year.

By Brian T. Horowitz • April 12, 2023

A Texas judge just turned back the clock on healthcare

The wiping out of preventive service requirements under the Affordable Care Act would render millions unable to receive life-saving preventive procedures, the CEO of the American College of Preventive Medicine argues.

By Donna Grande • April 12, 2023

Last year was second-best ever for healthcare private equity deals, Bain finds

PE transactions were buoyed by a strong first half of the year, with deals declining in the second half due to tensions from Russia’s invasion of Ukraine and growing inflationary pressures.

By Sydney Halleman • April 11, 2023

New York judge denies UnitedHealth’s request for summary judgment in TeamHealth lawsuit

U.S. District Judge John Koeltl rejected UnitedHealth’s argument that New York’s surprise billing law prevents providers from taking legal action against payers for alleged underpayments.

By Rebecca Pifer Parduhn • April 7, 2023

CMS cracks down on MA coverage denials and misleading ads in final rule

Both hospital and payer groups came out in support of the rule finalized Wednesday, finding common ground in the need to streamline prior authorization.

By Rebecca Pifer Parduhn • April 6, 2023

Some patients still pay for ACA-mandated free preventive care, study finds

Researchers in the study found that more than a third of patients incurred out-of-pocket expenses on the day of their ACA-mandated free preventative medical care service.

By Sydney Halleman • April 5, 2023

UnitedHealth executive returns to company 6 months after leaving for CVS

Amar Desai is back at UnitedHealth as senior adviser to CEO Andrew Witty.

By Rebecca Pifer Parduhn • April 3, 2023

Biden administration announces appeal to ACA preventive mandate ruling

The Justice Department on Friday appealed a Texas judge's ruling that struck down part of the ACA requiring health plans to fully cover certain preventive medical services like HIV drugs and cancer screenings.

By Hailey Mensik • April 3, 2023

CMS increases MA rate bump for 2024

Risk adjustment changes will now be phased in over three years, after payers pushed back on the proposed payment rule.

By Shannon Muchmore • April 3, 2023

Medicaid redeterminations have restarted. Here’s what we know

States began disenrolling ineligible beneficiaries from Medicaid earlier this year in an event the CMS has called the biggest health coverage transition since the first ACA open enrollment.

By Rebecca Pifer Parduhn , Sydney Halleman • March 31, 2023

CVS-Oak Street deal clears regulatory hurdle as antitrust waiting period expires

Oak Street also announced last week that it’s canceling its annual board meeting following the CVS deal, which is expected to close in the first half of the year. Oak Street stockholders will meet on April 28 to vote on the sale.

By Rebecca Pifer Parduhn • March 30, 2023

UnitedHealthcare cuts back prior authorization requirements

Provider groups applauded the move, but said they’d need to see how the requirements are rolled back before passing judgment on whether the step would ease documentation burdens on physicians.

By Rebecca Pifer Parduhn • March 30, 2023

Judge tosses ACA preventive care mandate

The Thursday ruling means that, effective immediately, health plans nationwide are no longer required to fully cover certain preventative medical services like cancer, HIV and diabetes screenings.

By Hailey Mensik • March 30, 2023

Warren calls on CMS to finalize MA payment change

Insurance and provider lobbies called on the CMS to delay the rule earlier this month, saying the methodology was flawed and arguing the 30-day comment period didn't give them enough time to analyze the proposed changes.

By Shannon Muchmore • March 29, 2023

AHIP, AHA join forces in amicus brief to SCOTUS False Claims Act case

The groups argue the expansion of the FCA would threaten the “legitimate business activities of every government contractor, hospital, healthcare provider, health insurance provider, and grant recipient in the nation.”

By Sydney Halleman • March 29, 2023

Ohio AG sues ‘modern gangsters’ Cigna, Humana for alleged PBM price fixing

Ohio Attorney General David Yost filed suit on Monday against the payers' PBMs, along with Prime Therapeutics, for allegedly sharing pricing information and driving up drug prices.

By Hailey Mensik • March 28, 2023

Oscar Health names former Aetna CEO Mark Bertolini as new chief executive

Bertolini brings decades of experience in the payer sector — including overseeing Aetna’s $70 billion sale to CVS in 2018 — to Oscar as the insurer works toward profitability.

By Rebecca Pifer Parduhn • March 28, 2023

North Carolina becomes 40th state to expand Medicaid

The expansion puts an end to a decade-plus political battle in North Carolina over Medicaid and illustrates mounting support for the program.

By Rebecca Pifer Parduhn • March 27, 2023

CVS closes $8B Signify acquisition

The combined company will work on care delivery and engagement, particularly for Medicare Advantage customers, according to an announcement.

By Rebecca Pifer Parduhn • Updated March 29, 2023

Moderna CEO defends price of COVID shot at Senate hearing

Stéphane Bancel said his company’s planned price hike covers the higher costs of commercial sales. Sen. Bernie Sanders called it part of industry’s “unprecedented level of corporate greed.”

By Christopher Newman • March 22, 2023

DOJ drops appeal against UnitedHealth’s acquisition of Change

In a Monday filing with a federal appeals court, the DOJ-led group agreed to withdraw its suit against a ruling that had allowed the merger.

By Sydney Halleman • March 22, 2023