Payer: Page 54
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'Pent up demand' spurs Centene Q2 net loss as more members seek care
Executives warned, however, that the delta variant is raging. "It remains clear that the pandemic is not over, and the environment could remain choppy for the balance of the year," CEO Michael Neidorff said.
By Samantha Liss • July 27, 2021 -
Anthem again ups 2021 expectations amid robust membership growth, contract wins
"We have also taken a slightly more cautious view of the back half of the year, in light of new COVID variants, coupled with a slowing vaccination rate," CFO John Gallina said Wednesday.
By Samantha Liss • July 21, 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 -
Medical debt overtakes nonmedical as largest source in collections. COVID-19 may be making it worse.
The study published in JAMA also found medical debt was significantly more concentrated in states that didn't expand Medicaid under the Affordable Care Act.
By Rebecca Pifer • July 21, 2021 -
Radiation therapy 'under attack' from CMS cuts, professional body warns
Equipment manufacturers including Varian, ViewRay, Hitachi, Siemens and Elekta could be affected by the reimbursement changes.
By Nick Paul Taylor • July 21, 2021 -
Large self-insured employers lack power in hospital price negotiations
A study in The American Journal of Managed care found that hospital market power far outweighs employer market power, suggesting employers may want to consider forging purchase alliances with local government employee groups.
By Samantha Liss • July 16, 2021 -
UnitedHealth brings in $71B in revenue, biding time on Biogen Alzheimer's drug coverage call
The health giant also expects both utilization and service acuity to trend up progressively in the back half of 2021. "We haven't observed that yet, but it's probably too early to say," CFO John Rex told investors Thursday.
By Rebecca Pifer • July 15, 2021 -
iStock
CMS proposes extension of Medicare telehealth coverage
Provider groups are not happy with the payment adjustment in the rule — a 3.75% reduction to the conversion factor due to budget neutrality requirements — and will likely seek congressional intervention.
By Shannon Muchmore • July 14, 2021 -
Sarah Silbiger via Getty Images
MDUFA talks expose 'fundamentally different' views of FDA and device companies
At the latest meeting over user fees, industry remained opposed to the agency's pitch for a Total Product Life Cycle Advisory Program, which it contends would extend the scope beyond FDA's purview.
By Nick Paul Taylor • July 14, 2021 -
Permission granted by Biogen
FDA revises labeling of Biogen Alzheimer's drug to emphasize early treatment
The drug's already controversial OK was made more so for applying to an exceptionally broad patient group. Critics argued the original label would spur use in those unlikely to benefit and balloon Medicare spending.
By Ned Pagliarulo , Ben Fidler • July 8, 2021 -
Danielle Ternes/Healthcare Dive
Q&ADexcom CEO on the Type 2 population, the Super Bowl ad and pandemic momentum
Kevin Sayer called Type 2 diabetes a "tremendous market opportunity" and said direct-to-consumer advertising is worth some controversy.
By Ricky Zipp • July 6, 2021 -
Alex Wong via Getty Images
CMS unveils new ESRD payment model in health equity push
The tweaks to the end-stage renal disease model is the CMS innovation center's first direct effort to address health disparities, a key priority for the Biden administration.
By Rebecca Pifer • July 2, 2021 -
Surprise Billing
First of surprise billing ban rules mum on arbitration details
The highly anticipated rule bans surprise out-of-network and balance billing beginning in 2022 for people in employer-sponsored or individual marketplace plans.
By Rebecca Pifer • July 1, 2021 -
Oklahoma Medicaid expansion kicks in, making eligible 190K low-income Americans
HHS Secretary Xavier Becerra congratulated the deep red state and urged the 13 remaining states that have yet to expand Medicaid to reconsider.
By Rebecca Pifer • July 1, 2021 -
Permission granted by Biogen
ICER stands by view on Biogen's Aduhelm, says sharp price cut needed
The influential nonprofit maintains that the clinical trial evidence supporting Aduhelm is insufficient to prove a health benefit. But even if some efficacy is assumed, ICER argues Biogen's $56,000 price tag is far too high.
By Ned Pagliarulo • June 30, 2021 -
Anthem completes acquisition of Puerto Rico-based MA, Medicaid plans
With the buy, the payer is doubling down on its government business, which fueled the majority of its enrollment growth last year as COVID-19 pummeled the country.
By Rebecca Pifer • June 30, 2021 -
Biden administration aims to further rebuild ACA with proposed rule
The regulation would lengthen the annual open enrollment period, expand the role of navigators and nix Trump-era guidelines for waivers that were criticized for allowing states to skirt coverage requirements.
By Shannon Muchmore • June 29, 2021 -
Courtesy of Humana
Interim Humana CFO made permanent
Susan Diamond was named to the interim role in March, when the Louisville, Kentucky-based insurer's then-CFO of seven years, Brian Kane, announced plans to step down to "pursue other opportunities."
By Jane Thier • June 28, 2021 -
Sean M. Haffey via Getty Images
San Diego sues Molina, Kaiser, Centene's HealthNet over alleged 'ghost networks'
Ghost networks, provider directories that list out-of-network physicians as in-network, cause consumers to think their coverage is more comprehensive than it actually is and can make access to care even more difficult.
By Rebecca Pifer • June 28, 2021 -
Medicare lacks cyber oversight of hospitals' networked medical devices: OIG
Without proper cybersecurity controls, these devices can be compromised with the potential for patient harm, according to the HHS watchdog. OIG wants CMS to do more to address hospital vulnerabilities.
By Nick Paul Taylor • June 25, 2021 -
Half of ambulance rides could result in surprise bill, KFF finds
A ban on surprise billing kicks into effect next year, but ambulances are exempt from the legislation, meaning patients will still be on the hook for those pricey, unexpected bills.
By Rebecca Pifer • June 25, 2021 -
Missouri judge blocks voter-approved Medicaid expansion
Despite of the win at the ballot box in 2020, the state legislature failed to make funds available to expand the program to about 230,000 low-income adults.
By Samantha Liss • June 24, 2021 -
As 5 Blue Cross Blue Shield plans join to tackle drug prices, some are skeptical
Another healthcare venture promises to lower costs, this time by using patient data on drug efficacy through a handful of large insurers.
By Samantha Liss • June 23, 2021 -
Alex Wong via Getty Images
CMS releases $20M in grants to bolster state-based marketplaces
States with their own eligibility platforms have enrolled more than 3.8 million people in ACA plans so far for the 2021 plan year. Many are now eligible for lower out-of-pocket costs or reduced monthly premiums.
By Rebecca Pifer • June 23, 2021 -
Pear secures $400M to scale up digital therapeutic business in SPAC deal
The developer of the first three FDA-authorized prescription digital therapeutics has ambitions to grow sales from a projected $4 million this year to $125 million in 2023.
By Nick Paul Taylor • June 23, 2021 -
Courtesy of Siemens Healthineers
UnitedHealthcare skimping on COVID-19 test pay, California doctor group alleges
The California Medical Association says UnitedHealthcare still is not covering the cost of all COVID-19 diagnostic testing, despite state and federal guidelines that require the services to be provided at no cost to patients.
By Susan Kelly • June 22, 2021
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