Payer: Page 56
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Adeline Kon/Healthcare Dive
Deep Dive4 key trends for payers and providers in 2022
The sectors face continued operational pressure as they head into a third year of the pandemic, including a tight labor market and shifts in payer mix.
By Samantha Liss • Jan. 21, 2022 -
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Deep DiveHow telehealth could be an equitable 'bridge to care' in a post-pandemic world
Much has been made of the technology's advantages, but it has its share of challenges when it comes to accessibility, experts said.
By Ryan Golden • Jan. 20, 2022 -
Mario Tama via Getty Images
Surprise BillingAHIP backs HHS in surprise billing suit, pushes back against provider claims
Relying on the qualifying payment amount, or median in-network rate, helps center the payment dispute, creating a starting point for when payers and providers may need to turn to a third-party arbiter, the lobby argued.
By Samantha Liss • Jan. 19, 2022 -
UnitedHealth reiterates MA growth expectations for 2022 as profits eclipse $4B
"Big picture, really positive," CEO Andrew Witty said about the fruitful MA market, despite dismal projections from some of UnitedHealth's peers about slowing enrollment.
By Rebecca Pifer Parduhn • Jan. 19, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
Antitrust regulators aim to revamp merger guidelines, signaling threat to health sector deals
The news sparked headlines about an attempt by regulators to target big tech, but it could have serious implications for healthcare for years to come.
By Samantha Liss • Jan. 19, 2022 -
Permission granted by Biogen
Medicare faces blowback over plan to limit coverage of Biogen's Alzheimer's drug
Biogen, along with allies in industry, plans to pressure Medicare to water down its policy, which limits coverage of Aduhelm and drugs like it to clinical trials.
By Jonathan Gardner , Jacob Bell • Jan. 14, 2022 -
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Healthcare sharing ministry 'sham' faces suit for allegedly defrauding consumers in California
Aliera allegedly scammed thousands of people by collecting monthly payments but denying coverage of medical costs, a lawsuit claims.
By Samantha Liss • Jan. 13, 2022 -
Permission granted by Biogen
Medicare proposes to limit coverage of Biogen Alzheimer's drug
The program will only cover Aduhelm, which the FDA controversially approved last June, for patients enrolled in clinical trials.
By Jonathan Gardner , Jacob Bell • Updated Jan. 11, 2022 -
Nic Antaya via Getty Images
Insurers will be required to cover 8 at-home COVID-19 tests per month
The Biden administration is incentivizing insurers to create programs that enable people to get tests from preferred pharmacies without paying upfront or needing to file a reimbursement claim.
By Nick Paul Taylor • Jan. 11, 2022 -
Mark Wilson via Getty Images
Becerra orders CMS to reassess Medicare premiums after Aduhelm cost cut
It's an unusual step for HHS, given the plan year has already begun, and follows Biogen slashing the price of its controversial Alzheimer's drug in half.
By Rebecca Pifer Parduhn • Jan. 10, 2022 -
Samantha Liss/Healthcare Dive
Centene reaches latest settlement over alleged PBM overcharging, agrees to pay New Hampshire $21M
The insurer has now settled with at least five states, paying out more than $236 million. It's possible more settlements are on the horizon, as Centene has set aside $1.1 billion for future payments.
By Samantha Liss • Jan. 10, 2022 -
Win McNamee via Getty Images
Stakeholders urge Supreme Court to act fast on OSHA mandate
"We are asking for a stay before enforcement takes effect Monday," an attorney for the National Federation of Independent Businesses said.
By Ryan Golden • Updated Jan. 10, 2022 -
Humana slashes Medicare Advantage outlook, shares tumble
Competition for members was "very aggressive" as Humana's competitors came in with lower-priced plans and spent more on marketing to attract customers away, CEO Bruce Broussard said.
By Samantha Liss • Jan. 7, 2022 -
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Biden admin proposes stricter network adequacy, marketing standards for MA plans
CMS is looking to hold Medicare Advantage plans to a higher standard as their rolls swell, targeting their networks, marketing practices and spending; while improving dual-eligible and Part D costs and patient input.
By Rebecca Pifer Parduhn • Jan. 7, 2022 -
Permission granted by The Boldt. Co.
Hospitals' labor expenses rose again just before omicron arrival, report finds
Expenses outpaced revenue growth as hospitals continued grappling with nationwide staffing shortages in November, according to Kaufman Hall.
By Hailey Mensik • Jan. 5, 2022 -
After years of decline, drugmakers' price hikes may have bottomed out
Inflation in 2021 may have offered drugmakers a catalyst for taking slightly bigger increases on a list price basis. But rebates to insurers are still keeping net price rises lower.
By Jonathan Gardner • Jan. 5, 2022 -
Centene closes $2.2B acquisition of Magellan Health
The deal is designed to broaden Centene's ability to provide "whole person" care, as the pandemic has highlighted the need to increase access to behavioral health services.
By Samantha Liss • Jan. 5, 2022 -
Molina closes $60M acquisition of Cigna's Medicaid contracts in Texas
Molina is known for being acquisitive, but has been on a recent tear as it looks to capitalize on growth in the Medicaid program.
By Rebecca Pifer Parduhn • Jan. 5, 2022 -
UnitedHealthcare permanently shelves controversial ER coverage changes following confusion
Following concerns from hospitals regarding an apparent change to its ER coverage policy, the payer clarified no changes were made — or will be made — to how it approves or denies its members' emergency claims.
By Rebecca Pifer Parduhn • Jan. 4, 2022 -
For the first time in 25 years, Centene looks for new CEO
Soon, the payer will begin searching for Michael Neidorff's successor, kicking off an executive search for the first time since he was installed in 1996.
By Samantha Liss • Dec. 22, 2021 -
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Insurers returned $2B to consumers for 2020 under ACA
The rebates, tied to lower medical loss ratios, were triggered as utilization rates dropped at the start of the COVID-19 pandemic.
By Susan Kelly • Dec. 21, 2021 -
Permission granted by Biogen
After intense pushback, Biogen to cut price of Alzheimer's drug
Effective Jan. 1, the average list price for Aduhelm will drop about 50% to just over $28,000 a year. It's a move the company hopes will appease insurers and lower out-of-pocket costs for patients.
By Jacob Bell • Dec. 20, 2021 -
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Flurry of doctor group buyouts helps fuel 'extraordinary' surge in health M&A
Companies across the healthcare spectrum are pursuing deals to strengthen operations after two years of pandemic-driven challenges, a new PwC report found.
By Susan Kelly • Dec. 14, 2021 -
Humana, Centene sue slate of drugmakers, alleging anticompetitive practices to protect HIV drug monopoly
Both payers have filed suit against Gilead, Teva, Janssen and Bristol Myers Squibb, alleging the drugmakers conspired to protect the market dominance of lucrative HIV medications despite the existence of generic alternatives.
By Rebecca Pifer Parduhn • Updated Dec. 15, 2021 -
Samantha Liss/Healthcare Dive
Neidorff to retire as Centene, activist investor group agree to board shakeup
The longtime CEO is now set to be replaced by the end of next year, and a new policy mandates a board retirement age of 75.
By Samantha Liss • Dec. 14, 2021
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