Payer: Page 5
-
Joe Raedle/Getty Images via Getty Images
Over 19M could enroll in ACA plans for 2024, CMS says
Enrollment in the Affordable Care Act exchanges could be boosted by extended subsidies and the effects of Medicaid redeterminations.
By Emily Olsen • Dec. 21, 2023 -
dventtr via Getty Images
Shared Savings Program linked to net losses in traditional Medicare, study finds
However, the program was associated with savings in Medicare Advantage and for the CMS overall.
By Emily Olsen • Dec. 20, 2023 -
Explore the Trendline➔
RossHelen via Getty Images
TrendlineSocial determinants of health
The focus on social determinants of health has only increased because of the impacts of the pandemic, with payers and providers trying to new ways to address the issues.
By Healthcare Dive staff -
AndreyPopov via Getty Images
UnitedHealth, OptumRx sued by independent pharmacy over ‘unconscionable’ fees
Osterhaus Pharmacy in Iowa — which is also suing CVS Caremark — is taking issue with pharmacy benefit managers’ use of performance-based fees that it says are contributing to independent pharmacy closures.
By Rebecca Pifer • Dec. 20, 2023 -
Kameleon007 via Getty Images
Medicaid redeterminationsBiden administration urges 9 states to curb high child Medicaid, CHIP disenrollments
Nine states account for about 60% of the decline in children’s Medicaid and Children’s Health Insurance Program enrollment from March through September, according to data from the CMS.
By Emily Olsen • Dec. 19, 2023 -
Alex Wong via Getty Images
Surprise BillingNo Surprises Act dispute portal reopens again amid ‘challenging’ policy rollout
The CMS has repeatedly stopped and restarted arbitration this year as court cases snarl regulatory efforts to resolve surprise billing disputes.
By Susanna Vogel • Dec. 18, 2023 -
Permission granted by Elevance Health
Elevance, BCBSLA resurrect $2.5B merger
The insurers are bringing a new plan to the table they think will assuage regulatory concerns after Elevance and BCBSLA shelved their proposed merger following public outcry in Louisiana.
By Rebecca Pifer • Dec. 18, 2023 -
Kerianne Condon/Healthcare Dive
Sponsored by Zelis[Podcast] Inside Healthcare APIs
This podcast series by Zelis explores how APIs can be leveraged to improve efficiency, offer a better experience, and drive innovation in the healthcare space.
Updated Feb. 20, 2024 -
Stock via Getty Images
CMS asks health plans, PBMs to ease up on independent pharmacies
A new letter urges payers to put in place special payment arrangements with pharmacies before a new policy kicks in that could reduce how much pharmacies are paid upfront.
By Rebecca Pifer • Dec. 15, 2023 -
iStock / Getty Images Plus via Getty Images
Health spending growth normalized in 2022 post-COVID, CMS says
Healthcare spending grew 4.1% in 2022, faster than 2021’s growth but notably slower than 2020’s, according to government actuaries.
By Rebecca Pifer • Dec. 14, 2023 -
Samantha Liss/Healthcare Dive
Centene tries to quell concerns of ACA overhaul during investor day
The Affordable Care Act has been under fire from Republican presidential candidates heading into an election year. But “once you giveth you cannot taketh away,” said the head of external affairs for the major marketplace carrier.
By Rebecca Pifer • Dec. 13, 2023 -
Courtesy of Humana
Humana used algorithm to deny care to Medicare Advantage patients, lawsuit claims
The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.
By Susanna Vogel • Dec. 13, 2023 -
Samuel Corum/Getty Images via Getty Images
House passes bill targeting price transparency, site-neutral payments, PBMs
Hospitals have lobbied against the site-neutral payment policies included in the bipartisan legislation.
By Sydney Halleman • Dec. 12, 2023 -
Getty Images via Getty Images
Health costs grew in line with overall inflation in 2023, new Turquoise data shows
The findings — some of the first from new price transparency data — illustrate how overall economic inflation could be catching up to faster health cost growth.
By Rebecca Pifer • Dec. 12, 2023 -
Matt Slocum/AP
Cigna pulls out of Humana deal: WSJ
Cigna and Humana are abandoning merger discussions less than two weeks after news of the potential deal dropped, following a less-than-positive market reaction.
By Rebecca Pifer • Dec. 11, 2023 -
Catherine Douglas Moran/Healthcare Dive
Kroger’s new benefits program expands access to affordable food
The tie-up with a healthcare technology company lets Medicare Advantage, Medicaid and other employer benefits program recipients use services at the grocer’s pharmacies as well as buy eligible food and over-the-counter items.
By Catherine Douglas Moran • Dec. 7, 2023 -
dventtr via Getty Images
Clover Health exits ACO REACH
The beleaguered insurer will leave the accountable care program at the end of the 2023 performance year following disappointing results in Medicare direct contracting.
By Rebecca Pifer • Dec. 6, 2023 -
zimmytws via Getty Images
CMS says states could lose funding over Medicaid redeterminations issues
The interim final rule comes as nearly 11.8 million people have been removed from the safety-net insurance.
By Emily Olsen • Dec. 5, 2023 -
Scott Olson via Getty Images
CVS overhauls how its retail pharmacies charge for prescription drugs
Under the new model, CVS’ pharmacy network will price drugs based on the amount the company paid for them, plus a defined markup and additional pharmacist fee.
By Rebecca Pifer • Dec. 5, 2023 -
stock via Getty Images
Deep DiveA Cigna-Humana merger could face a long regulatory delay. But it might get approved.
As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.
By Rebecca Pifer • Dec. 4, 2023 -
Permission granted by Pegasystems
Sponsored by PegasystemsEnhanced human potential: How customer service technology increases empathy
Elevance Health’s Geeta Wilson talks about improving operational efficiencies while enhancing member and associate satisfaction.
By Christopher Patterson, VP Product Strategy, Pegasystems • Dec. 4, 2023 -
Sean Pavone via Getty Images
North Carolina Medicaid expansion kicks in
About 600,000 more people in the state now have access to the safety-net insurance coverage.
By Rebecca Pifer • Dec. 1, 2023 -
Courtesy of UnitedHealth Group
Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook
UnitedHealth’s MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers, management said during an investor day.
By Rebecca Pifer • Nov. 30, 2023 -
Illustration: Xavier Lalanne-Tauzia for Industry Dive
Highmark Health’s insurance business boosts earnings
The insurance arm pushed the healthcare parent company to positive results during the first nine months of 2023 after its provider arm, Allegheny Health, reported an operating loss.
By Susanna Vogel • Nov. 29, 2023 -
Matt Slocum/AP
Cigna, Humana in talks to merge: WSJ
The merger would have major effects on the makeup of the U.S. health insurance industry, and would almost certainly face a regulatory challenge.
By Rebecca Pifer • Nov. 29, 2023 -
Sensay via Getty Images
Global medical costs to dip in 2024 — but respite may not last long, research finds
Medical costs will continue to rise over the next few years, according to WTW. Surveyed insurers blamed expensive medical technologies and an overuse of health services.
By Susanna Vogel • Nov. 29, 2023
Previous
