UnitedHealth expects to 'successfully overcome' DOJ challenge to Change acquisition

The company is bullish on completing its controversial acquisition of data analytics firm Change Healthcare, despite legal action from the Department of Justice to block the deal.

By Rebecca Pifer Parduhn • April 14, 2022

ACA marketplace premiums decline for third consecutive year, Urban Institute finds

The marketplace is bucking the trend of sustained premium increases for job-based coverage, which provides insurance to a majority of nonelderly Americans.

By Samantha Liss • April 13, 2022

Medicare finalizes policy limiting coverage of Biogen Alzheimer's drug

Treatment with Aduhelm would only be covered for patients enrolled in a clinical trial under the policy, which largely follows a draft proposal released in January.

By Jonathan Gardner • Updated April 7, 2022

Centene's former longtime leader Michael Neidorff dies

Neidorff transformed the St. Louis-based insurer into a formidable player in the healthcare sector during his 26 years at the helm.

By Samantha Liss • April 8, 2022

Biden proposes rule to fix ACA's 'family glitch'

The new regulation could help an estimated 200,000 uninsured people in the U.S. gain coverage, while 1 million could benefit from less expensive plans.

By Susan Kelly • April 6, 2022

CAR-T treatment moves earlier as FDA widens approval of Gilead's Yescarta

There are some obstacles to use. Yescarta is expensive, priced by Gilead at $373,000 per patient. Treatment is now widely covered by insurance, but the cost can still present hurdles for patients, depending on their coverage plans.

By Ned Pagliarulo • April 6, 2022

Facing opposition, Mass General Brigham pulls back surgery center plans

Although the system has withdrawn a proposal for three suburban surgery centers, it did secure recommendations for conditional approval for two other large-scale projects.

By Samantha Liss • April 5, 2022

Medicare Advantage plans will see 8.5% revenue bump in 2023

CMS is not changing the risk adjustment calculation, which is meant to compensate plans for treating sicker patients. That's despite calls for an overhaul in the wake of allegations of abuse of the system.

By Shannon Muchmore • April 5, 2022

Hospital E/M visit charges continued to rise in 2020, Fair Health finds

Meanwhile, the percentage of claims for telehealth shot up from just 0.22% of all claims in 2019 to about 15% in 2020, as COVID-19 restrictions set in and patients worried of virus transmission.

By Shannon Muchmore • March 30, 2022

Centene hit with $9M fine in Florida

Florida is freezing enrollment in Centene's plans, according to a March 17 letter sent to the CEO of the Florida division, the Sunshine State Health Plan.

By Samantha Liss • March 30, 2022

UnitedHealth to buy home health business LHC for $5.4B

A growing number of health insurers, private equity companies and hospitals are snapping up home health and hospice practices, with hopes for a substantial ROI.

By Rebecca Pifer Parduhn • March 30, 2022

Two years into the COVID-19 pandemic

Hospitals overhauled their operations in COVID-19's early days. Now, two years into the pandemic, they are looking ahead at the future of their business, including revenue diversification and workforce stability.

March 29, 2022

Record 14.5M Americans signed up for ACA coverage this year

But the generous subsidies that contributed to the increase in enrollment are temporary and set to expire at the end of the year absent congressional action.

By Rebecca Pifer Parduhn • March 24, 2022

Centene appoints London as CEO, succeeding longtime leader Neidorff

Sarah London specializes in data and technology and has quickly ascended the ranks at Centene, most recently rising to vice chairperson.

By Samantha Liss • March 23, 2022

Labor union health fund targets hospital prices, looks to form purchasing coalition

If successful, the coalition would bring together New York City's largest public employee union and the United Federation of Teachers. Together the group would represent about 540,000 people.

By Samantha Liss • March 22, 2022

Payer-to-payer data exchange rule to be published 'soon,' CMS head says at #HIMSS22

CMS hasn't been enforcing stipulations that payers share patient data with competitors set out in regulations finalized two years ago. But that could change soon with a new rule.

By Rebecca Pifer Parduhn • March 15, 2022

Biogen and its partner rework terms of Aduhelm deal amid slow sales

Instead of sharing global profits and losses, Eisai will receive royalties tied to net sales of the Alzheimer's drug. Biogen, meanwhile, said the amended deal should make it easier to "address market developments."

By Jacob Bell • March 15, 2022

Sutter Health defeats antitrust challenge in jury trial

The federal jury in a class action suit rejected allegations that the California hospital system drove up healthcare costs in its markets through anti-competitive practices.

By Susan Kelly • March 14, 2022

Grassley pushes for PBM probe

The senator wants FTC commissioners to come up with a more targeted focus for the study and suggested narrowing a review to the impact on consumers and their out-of-pocket costs.

By Samantha Liss • March 14, 2022

Anthem plans to change name to Elevance

It's the second name change for Anthem in the past decade. Prior to 2014, the company was known as WellPoint.

By Shannon Muchmore • March 10, 2022

Medical groups say prior authorization burdens persisted during pandemic

A new survey of doctor practices from the Medical Group Management Association found 98% of respondents wrestled with an increased or steady level of prior authorization requirements over the past year.

By Susan Kelly • March 8, 2022

L.A. Care fined $55M after members faced barriers to timely care

The fine is reportedly the largest in California history following an investigation that revealed serious systemic failures.

By Samantha Liss • March 7, 2022

Civica targets insulin in effort to produce cheaper drugs

The nonprofit group announced ambitious plans to begin offering insulin at prices no higher than $30 per vial by early 2024.

By Kristin Jensen • March 4, 2022

Humana adds Cerner's Feinberg to board amid activist pressure

Longtime Humana board member Marissa Peterson will not stand for reelection at the upcoming shareholder meeting, according to a proxy statement.

By Samantha Liss • Updated March 9, 2022

Primary care physician turnover costs payers almost $1B every year, study finds

Disruptions in care continuity when primary care providers leave their practices was a costly issue even before the pandemic, according to the American Medical Association.

By Hailey Mensik • March 3, 2022