Payer: Page 53
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Megan Quinn/Healthcare Dive
Senate passes legislation to avoid Medicare cuts in year-end sprint
The bill, which delays 2% cuts to Medicare rates through March and a separate round of 4% cuts to 2023, now heads to President Joe Biden's desk for his signature.
By Rebecca Pifer • Updated Dec. 10, 2021 -
Medicare Advantage quality bonus program hasn't improved quality, study finds
The new findings published in Health Affairs suggest the quality bonus program doesn't move the needle on quality despite a significant federal investment — hinting the American people may not be getting enough bang for their buck.
By Rebecca Pifer • Dec. 8, 2021 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
Julia Rendleman via Getty Images
Bright Health nabs $750M capital infusion with help from new investor (and competitor) Cigna
Cigna is investing $550 million in an apparent rival, attracted by its clinical network and opportunities to drive value there as more insurers look to snap up doctor's groups.
By Rebecca Pifer • Dec. 8, 2021 -
WhiteHouse.gov
Insurers now required to pay for at-home COVID-19 tests
Nearly 150 million insured Americans will benefit from the move, helping to lower their costs for the over-the-counter tests that can retail for around $25 for one kit.
By Samantha Liss • Dec. 2, 2021 -
Justin Sullivan via Getty Images
CVS, Microsoft ink alliance to develop digital health, personalized products
CVS is banking that Microsoft's computing capabilities can help it weave together its virtual and physical assets to capture a greater slice of patients' healthcare journeys — and the corresponding revenue.
By Rebecca Pifer • Dec. 2, 2021 -
UnitedHealthcare to appeal after jury awards TeamHealth $60M in damages
The payer is arguing the Las Vegas jury didn't get to hear several key pieces of evidence in its ongoing legal fight with private equity-backed TeamHealth.
By Rebecca Pifer • Updated Dec. 8, 2021 -
UPMC more than quadruples net income to $1.2B amid returning care and investment gains
Though patients returning to medical care delayed earlier in the pandemic helped its provider division, UPMC's health plan margin shrank due to higher medical claims in the period.
By Rebecca Pifer • Nov. 29, 2021 -
Humana, Allina Health expand value-based care partnership in Minnesota
The insurer also announced it extended another value-based care partnership for Medicare Advantage members with Hutchinson Clinic, a physician group in central Kansas.
By Susan Kelly • Nov. 24, 2021 -
Streeter Lecka via Getty Images
Anesthesiologists say Blue Cross NC 'abusing' surprise billing ban to drive down rates
Doctors are raising the alarm against what they perceive as Blue Cross NC's "take it or leave it" ultimatums to in-network clinicians, using the consumer protection legislation as a bargaining chip to negotiate more favorable rates.
By Rebecca Pifer • Nov. 23, 2021 -
Surprise Billing
Ground ambulances, excluded from surprise billing ban, to get scrutiny from federal committee
Recommendations from the new federal advisory committee will help inform policy changes to improve how charges and fees for ground ambulance services are disclosed to consumers, CMS said.
By Hailey Mensik • Nov. 22, 2021 -
Alex Wong via Getty Images
Biden admin proposes wide-reaching drug data collection in fourth surprise billing rule
Payers and employers will need to give HHS an annual overview of the top 50 drugs across different areas, including the most frequently dispensed drugs and the most expensive prescription drugs.
By Rebecca Pifer • Nov. 18, 2021 -
Insurtechs notched feverishly high MLRs in Q3. But it's not necessarily a mark of poor cost management
Despite strong year-over-year revenue growth, the finances of Bright, Clover and Oscar were walloped by coronavirus and risk adjustment headwinds.
By Rebecca Pifer • Nov. 17, 2021 -
Surprise Billing
Congress, alongside provider and consumer groups, continues spat over surprise billing ban rules
While payers and providers must start complying with the No Surprises Act by Jan. 1, the fight over rules implementing the ban is heating up as provider groups object to what they think is a favoring of insurers.
By Hailey Mensik • Nov. 17, 2021 -
Opinion
Congress: Target the middlemen who drive up drug costs
"The PBM market lacks the three elements essential for competition — choice, transparency and a lack of conflict of interest," antitrust attorney and former FTC policy director David Balto argues.
By David Balto • Nov. 15, 2021 -
Biogen's pricey Alzheimer's drug contributes to major Medicare premium hikes
The 15% jump in Part B premiums for 2022 is a case study in how just one expensive medication can affect the spending of millions in the U.S.
By Rebecca Pifer • Nov. 15, 2021 -
Permission for use provided by Zelis
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Learn more about innovative solutions that can help you comply with new regulations.
Nov. 15, 2021 -
Family premiums rise as employers boost virtual, mental health benefits, KFF finds
About half of employers with at least 200 workers reported healthcare utilization among their plan enrollees was in line with expectations for the most recent quarter, while 32% said it was below estimates.
By Hailey Mensik • Nov. 11, 2021 -
Anthem plans to buy Integra Managed Care in New York
The acquisition expands the payer's Medicaid business, a service line that has experienced major growth over the past year.
By Samantha Liss • Nov. 10, 2021 -
Health centers raise alarm about rolling back Medicaid coverage post-public health emergency
The clinics are worried about people with Medicaid coverage being deemed ineligible and losing insurance once states revert back to pre-pandemic Medicaid policies and eligibility, a new survey found.
By Rebecca Pifer • Nov. 10, 2021 -
Oak Street faces DOJ inquiry into third-party marketing, transportation relationships
Analysts said the inquiry, while in early stages, could pressure the company's stock. "This creates a new potential risk factor that we are unlikely to get clarity on for some time," SVB Leerink analyst Whit Mayo said.
By Rebecca Pifer • Nov. 9, 2021 -
Kaiser's operating margin dwindles as COVID-19 expenses, labor costs rise
Along with ongoing pandemic stresses, the California nonprofit is facing rising expenses amid intense workforce pressure as it faces the start of a major strike next week.
By Rebecca Pifer • Nov. 8, 2021 -
Insurer profitability remained strong in Q3 despite unexpectedly high COVID-19 costs
For most payers, higher-than-expected coronavirus costs were offset by patients continuing to delay nonessential medical care.
Nov. 5, 2021 -
Julia Rendleman via Getty Images
Cigna reports special enrollment period led to bump in medical claims, still posts $1.6B profit
Analysts characterized the third quarter results as mixed, even as the payer hiked its forecast for the remainder of the year.
By Samantha Liss • Nov. 4, 2021 -
Controversial UnitedHealth-Change tie-up gets new deadline for DOJ review
Consummation of UnitedHealth's $13 billion Change acquisition is now teed up for February at the earliest, though the deal could close even sooner if the DOJ unexpectedly drops its investigation — or later, if the agency challenges.
By Rebecca Pifer • Nov. 4, 2021 -
Courtesy of Humana
Humana cuts outlook after delta surge raises utilization expectations
Hospitalization trends were on par with January 2021, the height of the pandemic. As a result, Humana expects utilization to run higher than its original forecast, cutting into earnings expectations for the full year.
By Samantha Liss • Nov. 3, 2021
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