Virtual care and MA stars: value for seniors and for health plans

Kelly Bliss, Teladoc’s head of U.S. group health, makes the case for virtual care’s efficacy in improving MA star ratings.

By Kelly Bliss • Dec. 19, 2022

Centene again shakes up C-suite

The changes come as the insurer outlined its financial expectations for next year ahead of its investor day on Friday.

By Samantha Liss • Dec. 16, 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

Healthcare leaders expect turbulent operating environment next year

Staffing challenges and high inflation are expected to continue into 2023, along with affordability issues for patients, shrinking margins and continual supply chain disruptions, according to a survey from Deloitte.

By Hailey Mensik • Dec. 16, 2022

Scan Group, CareOregon to merge, forming $6.8B health plan

Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.

By Samantha Liss • Dec. 15, 2022

For ALS patients, doctors, a new medicine reignites concerns about healthcare access

The drug Relyvrio is in high demand in ALS clinics across the U.S. Though some patients are already getting it, insurance coverage and out-of-pocket costs remain a source of anxiety.

By Jacob Bell , Shaun Lucas • Dec. 15, 2022

CMS estimates 41.5M people affected by innovation center models since late 2020

The Center for Medicare and Medicaid Innovation is currently operating 33 models studying potential improvements in healthcare payment and delivery.

By Rebecca Pifer Parduhn • Dec. 14, 2022

Bright Health in danger of being booted from NYSE

The insurtech, which went public last year, has struggled with medical costs during the pandemic and has shrunk its business over the past year.

By Rebecca Pifer Parduhn • Dec. 13, 2022

CMS tackles provider availability, exchange regulations in proposed rule

The regulation comes after the ACA exchanges, spurred by financial incentives during the COVID-19 pandemic, reached record enrollment numbers.

By Sydney Halleman • Dec. 13, 2022

Variability in Medicare direct contracting savings illustrates promises, pitfalls of value-based care

Accountable care organizations' net savings rates ranged from -29.4% to 29.2% in the 2021 Global and Professional Direct Contracting Model.

By Rebecca Pifer Parduhn • Updated Dec. 13, 2022

Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH

At least 10 organizations with records of healthcare fraud and abuse participated in the direct contracting program last year despite CMS screening requirements, the letter said.

By Rebecca Pifer Parduhn • Updated Dec. 20, 2022

Centene reaches $17M settlement with Oregon

The payer has reached settlements with 13 states over allegations it overcharged Medicaid programs.

By Samantha Liss • Dec. 9, 2022

Payers, providers applaud new CMS prior authorization rule

Provider groups, including the AHA, asked the Senate to codify measures proposed by the CMS by passing bipartisan legislation imposing more prior authorization requirements on Medicare Advantage plans.

By Rebecca Pifer Parduhn • Dec. 8, 2022

UnitedHealth’s $5.4B buy of LHC expected to close in Q1

UnitedHealth’s buy of home health provider LHC Group for $170 a share could close as early as Jan. 6.

By Rebecca Pifer Parduhn • Dec. 7, 2022

CMS proposes new prior authorization requirements for payers, including MA plans

Regulators want payers to issue coverage decisions within 72 hours for urgent prior authorization requests — but the final turnaround time could be even shorter.

By Rebecca Pifer Parduhn • Dec. 7, 2022

18M projected to lose Medicaid coverage at end of COVID-19 emergency

Many people who are currently enrolled in Medicaid will transition to other coverage, but 3.8 million people will completely lose insurance, according to the Robert Wood Johnson Foundation.

By Susan Kelly • Dec. 6, 2022

Key healthcare stories from 2022

This year has been especially tumultuous for healthcare, with the overturning of Roe v. Wade, numerous labor disputes and major M&A announcements.

By Shannon Muchmore • Dec. 5, 2022

Emerging regulatory standards are paving the way for a new era: Unified experiences will be healthcare’s future

The impending changes to prior authorization processing aren’t minor, and they aren’t the only types of regulatory transformation that healthcare organizations will need to navigate in the months and years to come.

Dec. 5, 2022

UnitedHealthcare loses lawsuit to TeamHealth — again — in ongoing battle over billing

A three-judge arbitration panel in Florida has awarded $10.8 million to TeamHealth after finding UnitedHealthcare underpaid the physician group’s clinicians from 2017 to 2020.

By Rebecca Pifer Parduhn • Dec. 2, 2022

Texas Medical Association files third lawsuit over surprise billing ban

This latest filing targets the methodology for how payments are calculated and used during arbitration.

By Samantha Liss • Dec. 1, 2022

UnitedHealth Group projects up to $360B in 2023 revenue, buoyed by Optum growth

The projected revenue growth comes after the Department of Justice announced this month it would appeal a federal judge’s decision that allowed UnitedHealth’s $13 billion purchase of Change Healthcare to close.

By Sydney Halleman • Nov. 30, 2022

Bernie Sanders poised to lead Senate health committee

The longtime proponent of universal healthcare is set to become chair of the Health, Education, Labor and Pensions Committee. Sen. Bill Cassidy, R-La., is in line to be the committee’s ranking member.

By Susan Kelly • Nov. 28, 2022

Health insurance customer experience starts at open enrollment

Why health plan consumer experience matters; from the perspective of a stressed-out son.

By Maryann Waugh, Director of Content and Research • Nov. 28, 2022

Centene continues to sell ancillary business units

The sale of Magellan Specialty Health is the latest divestiture in Centene’s plan to sell non-core assets as part of a long-term strategy to improve the company’s profit margin.  

By Samantha Liss • Nov. 23, 2022

Lawmakers object to latest surprise billing rule, call for changes

House Ways and Means Committee leaders “are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before,” they wrote in a letter to regulators last week.

By Samantha Liss • Nov. 22, 2022

HHS to look at MA risk adjustment as upcoding in spotlight

Regulators have considered changing how they calculate patient risk and provider reimbursement, work that the HHS head said is continuing.

By Rebecca Pifer Parduhn • Nov. 17, 2022