Arbiters instructed to resume No Surprises Act determinations

The CMS had previously paused and resumed earlier disputes between payers and providers after a Texas judge ruled against the federal government and vacated portions of the law that bans surprise billing.

By Sydney Halleman • March 21, 2023

Provider directories remain inconsistent, despite No Surprises Act provisions

In a new study, researchers analyzed health plan provider directories for over 40% of U.S. physicians, and found inconsistencies for 81% of doctors across five major insurers.

By Rebecca Pifer Parduhn • March 17, 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

The health of a community depends on fair health insurance practices

Access to local and convenient care is critical for a community’s health. However, the current approach from payers puts this at risk, argues Antonio Rios, chief of population health at Northeast Georgia Health System.

By Antonio Rios • March 17, 2023

CMS lays out plans for negotiating drug prices

The guidance fills in details for one of the central pharmaceutical provisions of the Inflation Reduction Act, signaling how the agency will use its new authority.

By Christopher Newman • March 16, 2023

Majority of states plan to take their time with Medicaid redeterminations

Some states are proposing to unwind Medicaid coverage more slowly, while others are moving more quickly to focus on reducing budgetary costs, according to a survey from the Kaiser Family Foundation.

By Rebecca Pifer Parduhn • March 16, 2023

Oscar Health names current physician leader new CMO

Sean Martin is stepping up as chief medical officer of the New York-based insurer, after Oscar’s old CMO left to become CMO of L.A. Care Health Plan in December.

By Rebecca Pifer Parduhn • March 15, 2023

Physicians say prior authorization rules harm patients, AMA survey finds, as CMS works toward new policy

Over a third of physicians said the requirements led to a serious adverse event for one of their patients, such as hospitalization, permanent impairment or death, the survey found.

By Hailey Mensik • March 14, 2023

Biden’s proposed HHS budget aims to make pandemic-era subsidies permanent

The budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.

By Sydney Halleman • March 9, 2023

House committee latest to launch investigation into PBMs

It’s the most recent action targeting PBMs for allegedly using their market power to raise drug prices, and comes as the Federal Trade Commission also launched a similar investigation.

By Hailey Mensik • March 8, 2023

Insurers, trade groups ask CMS to delay MA rule

Insurance lobbyists argue that the 1.03% plan increase is insufficient and, in combination with other changes, would actually result in payment cuts.

By Sydney Halleman • March 7, 2023

FTC pushes back deadline for public to weigh in on noncompete ban

FTC Commissioner Christine Wilson said she would have supported an even longer extension since the proposed rule is “a departure from hundreds of years of precedent.” 

By Samantha Liss • March 7, 2023

Biden’s plan to improve Medicare solvency targets prescription drugs

The plan — part of Biden’s 2024 budget proposal set to be released Thursday — would further reduce what Medicare pays for prescription drugs and raise taxes on Americans earning over $400,000.

By Rebecca Pifer Parduhn • March 7, 2023

Bright Health chases cash after overdrawing credit facility

Bright is facing a new threat to its solvency after overdrawing on credit amid efforts to discontinue its health insurance exchange business.

By Rebecca Pifer Parduhn • March 1, 2023

Gross margins in MA market returned to pre-pandemic levels by end of 2021, report finds

The analysis of insurer markets in 2021, the latest year of available annual data, sheds light into the varied financial performance of insurers during the COVID-19 pandemic.

By Sydney Halleman • March 1, 2023

Hacking healthcare: With 385M patient records exposed, cybersecurity experts sound alarm on breach surge

Healthcare companies must harden their defenses, but it may require regulators and lawmakers to raise the bar on security standards, experts say.

By Jasmine Ye Han • Feb. 28, 2023

CMS says surprise billing arbitration can resume for some disputes — others remain on pause

Regulators are continuing to work on new guidance in light of a court decision that ruled against the government and threw a wrench in the third-party process to resolve payment disputes between payers and providers.

By Samantha Liss • Feb. 27, 2023

Humana exits employer insurance, pivots focus to government plans

The insurer said its employer segment no longer meets Humana’s long-term strategic plans.

By Samantha Liss • Feb. 24, 2023

Partisan gridlock shouldn’t threaten true value in healthcare

Oak Street CEO Mike Pykosz makes the case for value-based healthcare policy despite potential partisan gridlock in the 118th Congress.

By Mike Pykosz • Feb. 24, 2023

Cigna secures restraining order, barring executive from joining CVS

A judge said Cigna “would suffer irreparable harm absent a temporary injunction” and that it was “inevitable” that the employee, Amy Bricker, would share or use Cigna’s trade secrets while at CVS. 

By Samantha Liss • Feb. 22, 2023

UnitedHealth closes $5.4B buy of home health business LHC

LHC will become part of UnitedHealth’s health services arm Optum to help deliver integrated care, as demand for home and community care increases.

By Rebecca Pifer Parduhn • Feb. 22, 2023

Medicaid enrollees largely unaware of upcoming redeterminations, survey finds

About 64% of adults in a Medicaid-enrolled family said they didn’t know they could lose coverage once eligibility checks resume on April 1, a survey from the Robert Wood Johnson Foundation found.

By Hailey Mensik • Feb. 21, 2023

Could Medicaid redeterminations cause short-term health plan signups to spike?

Short-term plan operators will likely ramp up their marketing in April to nab new consumers from the Medicaid churn, but health policy experts largely aren't concerned.

By Rebecca Pifer Parduhn • Feb. 21, 2023

LHC to delist from Nasdaq, suggesting UnitedHealth could complete acquisition next week

LHC’s delisting, a sign that the deal’s close could be imminent, doesn’t come as a surprise, as the Nasdaq notified the home health provider it wasn’t in compliance with the stock market’s listing standards in January.

By Rebecca Pifer Parduhn • Feb. 16, 2023

Boston Scientific, MDMA call for more transparency, oversight of Medicare Advantage plans

Privately offered Medicare Advantage plans “do not often provide a clear reason for the denial of coverage, and rarely offer any visibility into the evidence and methodology,” trade group MDMA and Boston Scientific said.

By Nick Paul Taylor • Feb. 15, 2023

CMS plans trio of experiments aimed at lowering drug costs

The pilot programs could allow adjusted payments for drugs cleared under accelerated approval and help states manage the costs of gene therapies.

By Christopher Newman • Feb. 15, 2023