Unvaccinated COVID-19 hospitalizations costing US healthcare system billions, KFF says

Roughly 113,000 of the 185,000 inpatient stays with a COVID-19 diagnosis, or about 61%, could have been prevented by vaccination in June and July, researchers estimated.

By Rebecca Pifer • Aug. 24, 2021

Many insurers are no longer waiving cost sharing for COVID-19 treatment

This may pose a new strain for providers as people in the U.S. are left to cover their out-of-pocket costs, according to a report from the Kaiser Family Foundation.

By Samantha Liss • Aug. 20, 2021

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

SSM Health, insurer Medica to launch joint venture

Medica will invest an undisclosed sum in Dean Health Plan, a subsidiary of St. Louis-based SSM Health, one of the nation's largest nonprofit health systems.

By Samantha Liss • Aug. 19, 2021

Payments to MA plans raised overall Medicare spend by $7B in 2019, analysis finds

The Kaiser Family Foundation chalked the higher spending up to how MA is paid, including how benchmarks for plan payments are set and the risk adjustment process.

By Rebecca Pifer • Aug. 18, 2021

Centene's Medicare CFO promoted to segment CEO

Rich Fisher's promotion comes weeks after the insurer reported a $535 million quarterly loss but a 25% growth in its Medicare business.

By Jane Thier • Aug. 17, 2021

CMS extends deadlines for Medicaid redeterminations after COVID-19 public health emergency ends

Due to significantly increased workloads, state health officials will now have 12 months instead of six after the PHE ends to complete pending verifications, redeterminations and renewals.

By Hailey Mensik • Aug. 17, 2021

Centene awarded Ohio Medicaid contract following $88M settlement

In addition, a subsidiary of Molina has nabbed a Medicaid contract win in Nevada, the payer's first in the state.

By Rebecca Pifer • Aug. 17, 2021

UnitedHealthcare loses Medicare Advantage overpayment suit

An appeals court has reversed a 2018 decision overturning Medicare's overpayment rule that required insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support.

By Rebecca Pifer • Aug. 16, 2021

AI gains steam, though some execs still not sold at HIMSS21

Data released Wednesday finds 7% of healthcare executives said they believe AI and machine learning are the top priority for the future, while 7% called them a "distraction."

By Rebecca Pifer • Aug. 13, 2021

Predicting the future of healthcare: 10 takeaways from HIMSS21

Along with "guarded optimism" on the current state of the pandemic, some 19,000 on-site attendees in Las Vegas mulled what's next for AI, telehealth, cybersecurity, mental health and more.

By Rebecca Pifer , Hailey Mensik • Aug. 13, 2021

UnitedHealth settles for $15.6M after Labor Department finds mental health cuts, denials

"You should expect to see more investigation," of those not abiding by the federal mental health parity law, a top DOL official said. "I predict this will be a very active issue for us for years to come."

By Shannon Muchmore • Aug. 12, 2021

Health equity takes center stage at HIMSS21

Significant racial gaps in receiving vaccinations remain, despite the ongoing push to inoculate a greater swath of the U.S. population as the delta variant drives a surge in COVID-19 cases.

By Rebecca Pifer • Aug. 11, 2021

CVS Health's Aetna unveils nationwide primary care telehealth service

The vertically integrated healthcare giant is working with Teladoc to offer the program, which combines telehealth services and access to in-person visits with providers in the CVS Health-Aetna network.

By Susan Kelly • Aug. 11, 2021

Delaware caps hospital price growth to fund more primary care

Gov. John Carney signed the multi-pronged healthcare bill on Friday. "As I think about the things, particularly in healthcare that we focus on, there's not much that's more important than this," he said.

By Samantha Liss • Updated Oct. 5, 2021

Putting a stop to unjustified high drug prices

Find out how CVS Caremark is protecting payors and patients from overpriced medications

Aug. 9, 2021

Utilization bounced back for payers in Q2, dinging profitability

Patient volumes returned and drove net income down significantly year over year for insurers, which posted record profits during the same time last year when medical care was largely put off.

By Hailey Mensik • Aug. 6, 2021

Evernorth drives Cigna's Q2 revenue growth despite more return to care than expected

Executives said Thursday that COVID-19-related costs were also higher than anticipated for the quarter.  

By Shannon Muchmore • Aug. 5, 2021

OIG audit targets Aetna’s Medicare Advantage plans as government cracks down on fraud

CVS contends the reviews are a regular part of doing business in federal programs, and it "expects CMS and the OIG to continue these types of audits."

By Rebecca Pifer • Aug. 5, 2021

After controversial approval, doctors are still debating how to use Biogen's Alzheimer's drug

Nearly two months since Aduhelm became available, many physicians have yet to use the first treatment approved in the U.S. to slow Alzheimer's disease.

By Jacob Bell • Updated Aug. 3, 2021

CVS profit dips to $2.8B as patients return, COVID-19 costs persist

Lagging vaccination rates lead the company to expect the pandemic to be a "modest negative for 2021," CFO Shawn Guertin said. Previously, it expected COVID-19 to have little to no impact on full-year earnings.

By Rebecca Pifer • Aug. 4, 2021

Boston Scientific, Stryker get extra year of add-on payments as CMS adjusts to pandemic

Comments "overwhelmingly supported" the plan to use pre-pandemic data on the cost of inpatient stays to inform CMS' rates for fiscal 2022.

By Nick Paul Taylor • Aug. 3, 2021

CMS axes hospital price transparency mandate from 2022 inpatient payment rule

Hospitals will also receive a 2.5% pay bump for inpatient stays in 2022 under the new rule. That's lower than the 2.8% proposed in the initial draft, but "largely within the range of market expectations," one analyst wrote.

By Rebecca Pifer • Aug. 3, 2021

Molina sees bump in coronavirus inpatient costs as delta variant takes hold

Those COVID-19 costs quickly tapered off as the quarter progressed, executives said. Still, the insurer was able to post a second quarter profit as more members sought care. 

By Samantha Liss • July 29, 2021

How the pandemic has accelerated digital payments in telehealth

Digitalization can simplify the medical bill payment process and give patients more information earlier on about their financial responsibilities, experts said.

By J. Duncan Moore, Jr. • July 28, 2021

Humana warns of 'uncertainty' in medical usage amid rising COVID-19 cases

Medical utilization bounced back faster than the payer expected, though the company was still able to post a profit for the second quarter.

By Samantha Liss • July 28, 2021